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Fish Allergy

Finned fish can cause severe allergic reactions.  This allergy is usually life-long.  The protein in the flesh of fish most commonly causes the allergic reaction; however, it is also possible to have a reaction to fish gelatin, made from the skin and bones of fish.  Although fish oil does not contain protein from the fish from which it was extracted, it is likely to be contaminated with small molecules of protein and therefore should be avoided.

More than half of all people who are allergic to one type of fish also are allergic to other fish, so allergists often advise their patients to avoid all fish.  However, many people with fish allergies are able to eat canned tuna or salmon, which are less allergenic than fresh fish. Finned fish and shellfish do not come from related families of foods, so being allergic to one does not mean that you will not be able to tolerate the other.  Be sure to talk to your doctor about which kinds of fish you can eat and which to avoid.

When eating out, people with fish allergies should be particularly alert to cross-contamination.  Always check with the chef to make sure that the fish is not cooked on the same skillet or in the same oil as other food.  You also should make sure that your dishes are not prepared with the same utensils or on the same work surfaces as fish.

How to Avoid Fish*
The federal Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that any packaged food product that contains fish as an ingredient must list the name of the specific fish on the label.  Please be sure to read all product labels carefully before purchasing and consuming any item. Remember, also, that ingredients change from time to time, so check labels every time you shop.  If you are still not sure whether or not a product contains fish, call the manufacturer. Always take extra precaution when dining in restaurants or eating foods prepared by others.  If you are ever in doubt about any product or dish, don’t eat it.

The term “fish” encompasses all species of finned fish, including (but not limited to):  anchovies; bass; catfish; cod; flounder; grouper; haddock; hake; herring; mahi mahi; perch; pike; pollock; salmon; scrod; sole; snapper; swordfish; tilapia; trout; and tuna.

• Some sensitive individuals may react to aerosolized fish protein through cooking vapors.
• Seafood restaurants are considered high-risk due to the possibility of cross-contamination, even if you do not order fish.
• Ethnic restaurants (e.g., Chinese, African, Indonesian, Thai, and Vietnamese) are considered high-risk because of the common use of fish and fish ingredients and the possibility of cross-contamination, even if you do not order fish.
• Worcestershire sauce, Caesar salad, and Caesar dressing usually contain fish ingredients (anchovies).
• Caponata, a Sicilian eggplant relish, may contain anchovies.
• Surimi, an artificial crabmeat (also known as “sea legs” or “sea sticks”), is made from fish.
• Carrageen is a marine algae, not a fish, and is considered safe for those avoiding fish and shellfish.

* FAI wishes to thank the Jaffe Food Allergy Institute at Mount Sinai School of Medicine (New York, NY) for providing the allergen avoidance information in this article.