Fish Allergy Finned fish can cause severe allergic reactions (such as anaphylaxis). Therefore it is advised that people with fish allergy have quick access to an epinephrine auto-injector (such as an EpiPen®, Auvi-Q® or Twinject®) at all times. This allergy usually is lifelong. Approximately 40 percent of people with fish allergy experienced their first allergic reaction as adults.1 To prevent a reaction, strict avoidance of fish and fish products is essential. Always read ingredient labels to identify fish ingredients.

Salmon, tuna and halibut are the most common kinds of finned fish to which people are allergic. 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 fish-allergic patients to avoid all fish. If you are allergic to a specific type of fish but want to have other fish in your diet, talk to your doctor about the possibility of allergy testing for specific fish. Finned fish and shellfish do not come from related families of foods, so being allergic to one does not necessarily mean that you must avoid both.

Avoiding Fish The federal Food Allergen Labeling and Consumer Protection Ac (FALCPA) requires that all packaged food products sold in the U.S. that contains fish as an ingredient must list the specific fish used on the label.

Read all product labels carefully before purchasing and consuming any item. Ingredients in packaged food products may change without warning, so check ingredient statements carefully every time you shop. If you have questions, call the manufacturer.

As of this time, the use of advisory labels (such as “May Contain”) on packaged foods is voluntary, and there are no guidelines for their use. However, the FDA has begun to develop a long-term strategy to help manufacturers use these statements in a clear and consistent manner, so that consumers with food allergies and their caregivers can be informed as to the potential presence of the eight major allergens.

It has been estimated that there are upwards of 20,000 species of fish. Although this is not an exhaustive list, allergic reactions have been commonly reported to:

• Bass
• Catfish
• Cod
• Flounder
• Halibut
• Salmon
• Trout
• Tuna

Some Unexpected Sources of Fish*

• Caesar salad and Caesar dressing
• Worcestershire sauce
• Bouillabaisse
• Imitation or artificial fish or shellfish (surimi, also known as “sea legs” or “sea sticks,” is one example)
• Meatloaf
• Barbecue sauce
• Caponata, a Sicilian eggplant relish

*Note:  This list highlights examples of where fish has been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that fish is are always present in these foods; it is intended to serve as a reminder to always read the label and ask questions about ingredients before eating a food that you have not prepared yourself.

Keep the following in mind:

• Fish protein can become airborne in the steam released during cooking and may be a risk. Stay away from cooking areas.
• If you have seafood allergy, avoid seafood restaurants. Even if you order a non-seafood item off of the menu, cross-contact with fish is possible.
• 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-contact, even if you do not order fish.
• Avoid foods like fish sticks and anchovies. Some individuals with fish allergy make the mistake of thinking that such foods don’t “count as real fish.”
• Many people who are allergic to fish or shellfish are allergic to more than one kind. Get tested and have your allergies confirmed by a physician so that you know for sure which foods to avoid.
• 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.
• Carrageenan, or “Irish moss,” is not fish. It is a red marine algae that is used in a wide variety of foods, particularly dairy foods, as an emulsifier, stabilizer and thickener. It appears safe for most individuals with food allergies.
• Allergy to iodine, allergy to radiocontrast material (used in some radiographic procedures), and allergy to fish are not related. If you have an allergy to fish, you do not need to worry about cross reactions with radiocontrast material or iodine.