Allergy & Asthma-Kent H. DeYarman, MD

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Fish Allergy

Fish is a common food causing IgE allergic reactions (see Food Allergy handout). IgE types of food allergies cause immediate and potentially very severe life threatening reactions when even small amounts of the food are ingested. Managing this type of reaction requires awareness of sources of fish, having adrenalin (usually in the form of an EpiPen) available, and use of Medic Alert bracelets.


Fish (bony fish) are allergically unrelated to shellfish and allergy to fish does not mean you will be allergic to shellfish. Most people who are allergic to fish will react to many species of fish but some people react to only one species. Some people will react if the fish is raw but not if well cooked.


We do not know about all cross reactions between fish species and people who are allergic to one fish should avoid all fish because of this. Some people do continue to eat species of fish they have eaten in the past without reaction but this is risky. Fish allergies can be quite severe and reactions have been seen after exposure to cooking odors from fish or from touching fish.


Fish are relatively easy to avoid but be cautious in restaurants where fish may be cooked in the same cookware as other dishes. Make sure the dishes and pans have been washed with soap and water before your meal is prepared in them. In general it is best to avoid seafood restaurants even if you are not ordering seafood.


The FOOD ALLERGY NETWORK has additional and frequently updated information about reactions to fish and other foods.


Food Allergy Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030-3179
703.691.3179 Fax 703.691.2713


You should carry an EpiPen and know how to use it. Caregivers also need to be instructed. Children can carry an EpiPen at school with a note from our office. EpiPens may be given through clothing. If the EpiPen is used, you need to be seen and observed in an emergency room. Reactions have recurred even 2-3 hours after the initial reaction seemed to be improving.


If you have an anaphylactic reaction to fish, spit the food out of your mouth, rinse and spit with water or other liquid, and use the EpiPen. USE THE EPIPEN AT THE EARLIEST SIGN OF A REACTION. You should also consider going to an emergency room unless the reaction was very mild. Even then there is a risk it could recur. Do not go to a restroom or other private place to use the EpiPen. Notify someone you are having an allergic reaction, tell them you are giving yourself a shot, and ask them to call 911. Wearing your Medic Alert bracelet is important and lets emergency personnel know what is happening if you are unable to communicate with them.


Patients at risk of anaphylaxis to foods or other materials should avoid beta blocker medications (used for heart, blood pressure, and glaucoma problems) as these will block the effect of the EpiPen.


With these precautions of avoidance, Medic Alert bracelet and availability of EpiPen fish allergy is a manageable problem. Although there have been rare exceptions fatal reactions almost never occur when an EpiPen is available and used early in the event of a reaction. New treatments for fish and similar food allergies may be available within the next few years.