Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Coping

A fish allergy, as opposed to ashellfish allergy, is one in which your immune system reacts abnormally to a finned fish such as tuna, halibut, or salmon. It is a somewhat less common form offood allergy, affecting women more than men and adults more than children.

Fish allergies often develop during early childhood but, in contrast to amilkoregg allergy, usually persist well beyond school age. Symptoms can range from mild to severe and may include skin rashes, respiratory symptoms, gastrointestinal distress, andanaphylaxis(which requires emergency attention).

Fish Allergy Symptoms

Fish allergy symptoms are similar to those of other food allergies, and most occur within an hour of eating. They include:

If not treated immediately with an injection of epinephrine and other emergency interventions, anaphylaxis can lead to shock, coma, cardiac or respiratory failure, and even death.

The normal role of histamine is to dilate blood vessels so that larger immune cells can access the site of an injury or infection. In the absence of an injury or infection, histamines can trigger the skin, respiratory, and gastrointestinal symptoms we recognize as allergic reactions.

The primary allergen responsible for a fish allergy is a protein known asparvalbumin. Parvalbumins vary little between different fish species, meaning that an allergy to one fish will usually result in an allergy to other fishes (a condition known as polysensitization).

Parvalbumins are extremely heat-tolerant and do not break down easily even after hours of cooking. As such, you may be just as sensitive to a piece of baked salmon as you are to raw sashimi.

Interestingly, while you may be allergic to different types of fish, having a fish allergy does not predispose you to a shellfish allergy. A shellfish allergy involves an entirely different allergen known as tropomyosin, which is found in crustaceans and mollusks.

Fish Associated With Allergy

Among the more than 20,000 known fish species, there are several for which the risk of allergy is especially high. According to research published in theFrontiers of Immunity, they include:

Other Foods

Fish gelatin, derived from the bones and cartilage of fish, is often used as a setting agent in pepperoni, hot dogs, and other types of processed meats. Similarly, fish meal is commonly used in certain organic fertilizers.

If the tests aren’t conclusive, your allergist may recommend an oral food challenge. This is a procedure in which you eat a small amount of fish to see if you have a reaction.

Because the response to an oral food challenge may be severe, it is only performed in the presence and under the direction of a medical professional who can deliver emergency treatment if needed.

An oral food challenge should never be performed as an in-home experiment.

Differential Diagnoses

To ensure that fish is the source of your symptoms and not some other condition, your healthcare provider may want to explore other possible causes. One such example is scrombroiosis, a type of food poisoning in which high levels of histamine are produced as a fish begins to spoil.

Less commonly, some people may experience cross-reactivity to chicken and fish in which a true allergy to chicken parvalbumins can sometimes trigger a cross-reactive response to fish.

Fish is one of eight allergens that must be listed on all food ingredient labels under the Food Allergen Labeling and Consumer Protection Act of 2004. Under the law, the manufacturer must identify the type of fish used and ensure that is it clearly indicated in easy-to-understand language.

If your allergy symptoms are mild, you can often treat them with an over-the-counteroral antihistamine. If you are at risk of a severe reaction, you may be advised to carry a single-use, pre-filled epinephrine injector, such as anEpiPen, which you would inject into your thigh in case of an emergency.

Unlike other forms of allergy, food allergies cannot be treated with allergy shots (immunotherapy).

While a fish allergy may be less common than a seafood ornut allergy, it can be every bit as serious. To this end, you should take steps to protect yourself if you have been diagnosed with a fish allergy.

Among some of the more useful tips:

A Word From Verywell

While some allergies can be annoying, others can be downright deadly. If you have had anaphylaxis in the past or are at risk, consider wearing anemergency medical braceletoutlining your condition, recommended treatments, and drugs to avoid.

In this way, if you are unconscious or unable to reply, the emergency medical team can take appropriate action without losing precious time.

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hilger C, Van hage M, Kuehn A.Diagnosis of allergy to mammals and fish: Cross-reactive vs. specific markers.Curr Allergy Asthma Rep. 2017;17(9):64. doi:10.1007/s11882-017-0732-zAmerican College of Allergy, Asthma & Immunology.Fish allergy.Kuehn A, Swoboda I, Arumugam K, Hilger C, Hentges F.Fish allergens at a glance: Variable allergenicity of parvalbumins, the major fish allergens.Front Immunol. 2014;5:179. doi:10.3389/fimmu.2014.00179Wong L, Huang CH, Lee BW.Shellfish and house dust mite allergies: Is the link tropomyosin?Allergy Asthma Immunol Res. 2016;8(2):101-6. doi:10.4168/aair.2016.8.2.101Tortorella V, Masciari P, Pezzi M, et al.Histamine poisoning from ingestion of fish or scombroid syndrome. Case Rep Emerg Med. 2014;2014:482531. doi:10.1155/2014/482531Friedman MA, Fernandez M, Backer LC, et al.An updated review of Ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management.Mar Drugs. 2017;15(3). doi:10.3390/md15030072Additional ReadingCianferoni, A. and Muraro, A.Food-Induced Anaphylaxis.Immunol Allergy Clin North Am. 2012:32(1):165-95. DOI :10.1016/j.iac.2011.10.002.Hilger, C.; van Hage, M.; and Kuehn, A.Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers.Curr Allergy Asthma Rep. 2017; 17(9): 64. DOI: 10.1007/s11882-017-0732-z.Kuehn, A.; Codreanu-Morel, F.; Lehners-Weber, C. et al.Cross‐reactivity to fish and chicken meat – a new clinical syndrome.Allergy(Eur). 2016;71(12):1772-81. DOI:10.1111/all.12968.Kuehn, A.; Swoboda, I.; Arumugam, K. et al.Fish Allergens at a Glance: Variable Allergenicity of Parvalbumins, the Major Fish Allergens.Front Immunol. 2014: 179. DOI: 10.3389/fimmu.2014.00179.

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hilger C, Van hage M, Kuehn A.Diagnosis of allergy to mammals and fish: Cross-reactive vs. specific markers.Curr Allergy Asthma Rep. 2017;17(9):64. doi:10.1007/s11882-017-0732-zAmerican College of Allergy, Asthma & Immunology.Fish allergy.Kuehn A, Swoboda I, Arumugam K, Hilger C, Hentges F.Fish allergens at a glance: Variable allergenicity of parvalbumins, the major fish allergens.Front Immunol. 2014;5:179. doi:10.3389/fimmu.2014.00179Wong L, Huang CH, Lee BW.Shellfish and house dust mite allergies: Is the link tropomyosin?Allergy Asthma Immunol Res. 2016;8(2):101-6. doi:10.4168/aair.2016.8.2.101Tortorella V, Masciari P, Pezzi M, et al.Histamine poisoning from ingestion of fish or scombroid syndrome. Case Rep Emerg Med. 2014;2014:482531. doi:10.1155/2014/482531Friedman MA, Fernandez M, Backer LC, et al.An updated review of Ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management.Mar Drugs. 2017;15(3). doi:10.3390/md15030072Additional ReadingCianferoni, A. and Muraro, A.Food-Induced Anaphylaxis.Immunol Allergy Clin North Am. 2012:32(1):165-95. DOI :10.1016/j.iac.2011.10.002.Hilger, C.; van Hage, M.; and Kuehn, A.Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers.Curr Allergy Asthma Rep. 2017; 17(9): 64. DOI: 10.1007/s11882-017-0732-z.Kuehn, A.; Codreanu-Morel, F.; Lehners-Weber, C. et al.Cross‐reactivity to fish and chicken meat – a new clinical syndrome.Allergy(Eur). 2016;71(12):1772-81. DOI:10.1111/all.12968.Kuehn, A.; Swoboda, I.; Arumugam, K. et al.Fish Allergens at a Glance: Variable Allergenicity of Parvalbumins, the Major Fish Allergens.Front Immunol. 2014: 179. DOI: 10.3389/fimmu.2014.00179.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Hilger C, Van hage M, Kuehn A.Diagnosis of allergy to mammals and fish: Cross-reactive vs. specific markers.Curr Allergy Asthma Rep. 2017;17(9):64. doi:10.1007/s11882-017-0732-zAmerican College of Allergy, Asthma & Immunology.Fish allergy.Kuehn A, Swoboda I, Arumugam K, Hilger C, Hentges F.Fish allergens at a glance: Variable allergenicity of parvalbumins, the major fish allergens.Front Immunol. 2014;5:179. doi:10.3389/fimmu.2014.00179Wong L, Huang CH, Lee BW.Shellfish and house dust mite allergies: Is the link tropomyosin?Allergy Asthma Immunol Res. 2016;8(2):101-6. doi:10.4168/aair.2016.8.2.101Tortorella V, Masciari P, Pezzi M, et al.Histamine poisoning from ingestion of fish or scombroid syndrome. Case Rep Emerg Med. 2014;2014:482531. doi:10.1155/2014/482531Friedman MA, Fernandez M, Backer LC, et al.An updated review of Ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management.Mar Drugs. 2017;15(3). doi:10.3390/md15030072

Hilger C, Van hage M, Kuehn A.Diagnosis of allergy to mammals and fish: Cross-reactive vs. specific markers.Curr Allergy Asthma Rep. 2017;17(9):64. doi:10.1007/s11882-017-0732-z

American College of Allergy, Asthma & Immunology.Fish allergy.

Kuehn A, Swoboda I, Arumugam K, Hilger C, Hentges F.Fish allergens at a glance: Variable allergenicity of parvalbumins, the major fish allergens.Front Immunol. 2014;5:179. doi:10.3389/fimmu.2014.00179

Wong L, Huang CH, Lee BW.Shellfish and house dust mite allergies: Is the link tropomyosin?Allergy Asthma Immunol Res. 2016;8(2):101-6. doi:10.4168/aair.2016.8.2.101

Tortorella V, Masciari P, Pezzi M, et al.Histamine poisoning from ingestion of fish or scombroid syndrome. Case Rep Emerg Med. 2014;2014:482531. doi:10.1155/2014/482531

Friedman MA, Fernandez M, Backer LC, et al.An updated review of Ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management.Mar Drugs. 2017;15(3). doi:10.3390/md15030072

Cianferoni, A. and Muraro, A.Food-Induced Anaphylaxis.Immunol Allergy Clin North Am. 2012:32(1):165-95. DOI :10.1016/j.iac.2011.10.002.Hilger, C.; van Hage, M.; and Kuehn, A.Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers.Curr Allergy Asthma Rep. 2017; 17(9): 64. DOI: 10.1007/s11882-017-0732-z.Kuehn, A.; Codreanu-Morel, F.; Lehners-Weber, C. et al.Cross‐reactivity to fish and chicken meat – a new clinical syndrome.Allergy(Eur). 2016;71(12):1772-81. DOI:10.1111/all.12968.Kuehn, A.; Swoboda, I.; Arumugam, K. et al.Fish Allergens at a Glance: Variable Allergenicity of Parvalbumins, the Major Fish Allergens.Front Immunol. 2014: 179. DOI: 10.3389/fimmu.2014.00179.

Cianferoni, A. and Muraro, A.Food-Induced Anaphylaxis.Immunol Allergy Clin North Am. 2012:32(1):165-95. DOI :10.1016/j.iac.2011.10.002.

Hilger, C.; van Hage, M.; and Kuehn, A.Diagnosis of Allergy to Mammals and Fish: Cross-Reactive vs. Specific Markers.Curr Allergy Asthma Rep. 2017; 17(9): 64. DOI: 10.1007/s11882-017-0732-z.

Kuehn, A.; Codreanu-Morel, F.; Lehners-Weber, C. et al.Cross‐reactivity to fish and chicken meat – a new clinical syndrome.Allergy(Eur). 2016;71(12):1772-81. DOI:10.1111/all.12968.

Kuehn, A.; Swoboda, I.; Arumugam, K. et al.Fish Allergens at a Glance: Variable Allergenicity of Parvalbumins, the Major Fish Allergens.Front Immunol. 2014: 179. DOI: 10.3389/fimmu.2014.00179.

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