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The Ultimate Guide on Living with a Fish Allergy

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Sharon had her first allergic reaction to fish at the age of 52. She had gone out to eat with a friend and ordered salmon, something she had eaten several times before. But, this time was different. After eating the salmon her skin broke out in hives and her lips swelled.

Thankfully, she got the medical attention she needed. But it left her with a lot of questions. Is it common to develop an allergy to fish as an adult? What do I have to do to stay safe with a fish allergy?

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. Keep in mind food production can change, always check food labels to be sure products are free of your particular food allergen. For further information please see full Disclaimer.

Is a Fish Allergy Common?

6.6 million Americans have either a  Physician-diagnosed and/or convincing seafood allergy which is about 2.3% of the general population. A seafood allergy includes both fish and shellfish.

Food Allergy Research and Education (FARE) notes that of this 2.3% about 1% of this is from a fish allergy. This is roughly 3 million Americans who have a fish allergy.  

What are the 9 Most Common Food Allergies?

The top 9 food allergies also known as the big 9 allergens in the United States are:

  1. Milk
  2. Egg
  3. Peanut
  4. Soy
  5. Wheat
  6. Tree Nut
  7. Shellfish
  8. Fish
  9. Sesame
The Top 9 Food Allergens in the U.S. Top 9 Food Allergies.  1.  Fish 2. Shellfish 3. Tree Nuts 4. Peanuts 5. Milk 6. Wheat 7. Egg 8. Soy 9. Sesame

You can be allergic to many other foods besides these top nine. 

Is it Common to have a First Allergic Reaction to Fish as an Adult?

Yes, it is very common to have a fish allergy develop as an adult.

According to FARE (Food Allergy Research and Education), 40% of individuals with a fish allergy develop their first allergic reaction in adulthood.

What are Symptoms of a Fish Allergy?

Food allergy symptoms can vary from person to person but some typical reactions are listed below. Reactions may range from mild to severe and may occur a few minutes to a few hours after eating fish.  

  • Hives
  • Swelling
  • Anaphylaxis
  • Itching or swelling of the lips, tongue, or throat
  • Diarrhea
  • Difficulty swallowing
  • Abdominal pain and cramps
  • Nausea and vomiting
  • Runny nose
  • Digestive problems
  • Coughing
  • Loss of consciousness

A fish allergy tends to be lifelong in most cases.

Types of Fish

There are more than 20,000 different types of fish. Here are some common types of fish in the United States that may cause allergic reactions:

  • Anchovies
  • Bass
  • Catfish
  • Cod
  • Eel
  • Flounder
  • Grouper 
  • Haddock
  • Halibut
  • Herring
  • Mahi Mahi
  • Perch
  • Pollock
  • Salmon 
  • Shark
  • Sole
  • Snapper
  • Swordfish
  • Tilapia
  • Trout
  • Tuna

Interestingly, salmon, tuna, and halibut are some of the more common types of finned fish to cause an allergic reaction.

It is very common to be allergic to more than one type of finned fish.

Foods to Avoid with a Fish Allergy

Avoid any foods that have fish flavoring. Barbeque sauce, ceviche, caviar, cioppino, nam pla, fumet, surimi, caponata, bouillabaisse, Caesar Salad and Caesar dressing, worcestershire sauce, fish oil (including many omega 3 supplements), Pissaladière, fish sticks, and fish gelatin are foods that may contain fish.

It is important to avoid imitation or artificial fish or shellfish such as sea legs, sea sticks or surimi.  They tend to contain fish.

Isinglass is a gelatin made from fish. It may be used for the clarification of some beer and wine. If you have a fish allergy, you need to be aware of which wine and beer products use isinglass.  

Unfortunately,  alcoholic beverages do not need to list ingredients on the label. Therefore, you will need to call the particular manufacturer.

When ordering food at a restaurant, even if you ask for a dish that is free from fish, there may be a high risk of cross contamination. This is especially true at Thai, Vietnamese, Chinese, Indonesian, and African restaurants. Be sure to ask about how the food is prepared.

Foods to Investigate or Restrict with a Fish Allergy
This list is not all inclusive.

Food Allergy Labeling.  About FALCPA

In 2004, the Food Allergen Labeling and Consumer Protection Act (FALCPA), identified the following foods as major food allergens:  milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy.

Effective January 1, 2023, the FASTER Act  (the Food Allergy Safety, Treatment, Education, and Research Act) was signed into law, adding sesame as the 9th major food allergen recognized in the U.S. 

FALCPA  requires that foods or ingredients that contain major food allergens be labeled with the name of the allergen source. 

FALCPA states that major food allergens should be listed in one of three ways:

  1. In the ingredient list, using the allergen’s common name.  Example:  Ingredients:  Fish (pollock).
  2. By  citing the word “Contains” followed by the name of the major food allergen—for example, “Contains fish (salmon), milk, eggs, peanuts.”
  3. In the ingredient list in parentheses after a less common name of the allergen.

Made in a Facility/Cross Contamination Statements

Food manufacturers may use equipment to produce multiple products. This may lead to cross contamination of allergens.  Some manufacturers disclose this information and others do not.  This is true for both FALCPA and non-FALCPA allergens.

In the U.S., cross contamination statements are not a requirement. Call the manufacturer to learn about their manufacturing practices.

If you have a fish allergy and do not have a shellfish allergy, risk of cross contamination may be significant when dining at a restaurant that serves both fish and shellfish.

Fish Allergy Treatment

  1.  Always read food labels and look for fish ingredients
  2. Avoid all fish and fish products
  3. Talk to your Board Certified Allergist
  4. Be mindful of risk for cross contamination
  5. Treat your fish allergy in the case of accidental ingestion. Be sure to have not one, but two doses of epinephrine available when eating. Talk to your doctor about how to treat symptoms of an allergic reaction and visit www.foodallergy.org for more detailed information about treating food allergies.

Final Thoughts

It is not uncommon to develop a fish allergy as an adult. An allergy to fish does not mean an allergy to shellfish.

Ask about how food is prepared when dining out with a fish allergy.   

Always read food labels.

Carry two doses of epinephrine when consuming food in case of a serious allergic reaction.  

If you think you may be allergic to fish see a Board Certified Allergist.

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Last Updated on February 8, 2023 by Amber DeVore, RD, CSSD, CLT

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