Fish Allergy Management

Introduction to Fish Allergy

The American Academy of Allergy, Asthma, and Immunology recommends that individuals with a fish allergy should strictly avoid raw fish (such as raw fish) because fish allergens are resistant to cooking and can cause severe reactions, including potentially fatal anaphylaxis 1, 2

The American Academy of Allergy, Asthma, and Immunology suggests that before restricting the diet, diagnostic confirmation is essential, and this can involve oral food challenge in a controlled setting to confirm clinical allergy, as 50-90% of presumed food allergies are not confirmed 4
The American Academy of Allergy, Asthma, and Immunology recommends that the oral food challenge should start with a minimal dose and be stopped at the first symptoms (often oral pruritus or nausea), as even a small amount can trigger anaphylaxis 5

The American Academy of Allergy, Asthma, and Immunology advises that anyone with a documented fish allergy should strictly avoid their specific allergens, and this includes learning to read food labels and identifying fish-derived ingredients 1, 5
The American Academy of Allergy, Asthma, and Immunology recommends that individuals with a history of respiratory symptoms or hypotension during a reaction should always carry two epinephrine auto-injectors 5, 6

The American Academy of Allergy, Asthma, and Immunology notes that coexisting asthma is the most associated factor with severe reactions and deaths from food anaphylaxis, and that peanuts and tree nuts cause the majority of deaths, but fish and shellfish are also frequent triggers of fatal anaphylaxis 4, 2, 6

The American Academy of Allergy, Asthma, and Immunology suggests consultation with an allergist-immunologist for comprehensive evaluation and identification of triggers, and recommends nutritional and growth surveillance for all children with food allergy 6, 1, 7