Living with a fish allergy

Does a fish allergy mean that your child can’t eat a) one specific species of fish, b) all fish of a certain color, or c) anything with scales and a tail that lives under water? The answer is, um, it really depends on the person. Fish allergies can be to only a few different types of fish or to all fish, and it isn’t always easy to tell which is which. This can be confusing if a child has had one type of fish with no problems in the past, but but has an allergic reaction when trying a new type of fish. Your child’s allergist will be able to talk to you about more common cross-sensitivities, and how to handle different types of fish moving forward.

What is a fish allergy?

A fish allergy is a condition where a child’s body reacts to harmless proteins in all or certain fish as if they are a threat, which triggers an immune system response. This immune system response can, itself, be dangerous and uncomfortable.

Where else is fish found?

Since about half of all people who are allergic to one kind of fish are allergic to other kinds of fish as well, most doctors recommend that children who have had an allergic reaction to fish avoid all types of fish in the future. Fish can seem like a pretty easy ingredient to avoid – just hold the sushi and steer clear of fish and chips shops, right? But fish and fish products can the the surprise ingredients that can show up in many other dishes, including sauces like barbecue sauce, Worcestershire sauce, Caesar dressing, and in imitation or artificial fish or shellfish (or surimi).

The fact that fish products can turn up in sometimes-unexpected places means that parents of children with fish allergies should get used to reading the ingredients lists on all foods, even the ones that might seem to obviously not contain fish. Your child’s allergist may also recommend avoiding seafood restaurants, and restaurants of cuisines which use lots of fish, or which commonly use fish sauce, since even if you order a fish-free dish for your child, there’s still the risk of cross-contamination.

How is a fish allergy treated?

For all allergies, the first and most important treatment of avoidance. When a reaction happens, for severe allergies, healthcare providers prescribe epinephrine, or adrenaline, which is dispensed from an auto-injector, or EpiPen. EpiPens should be stored at room-temperature, and should avoid extremes of heat and cold. Many families find it helpful to have several EpiPens – say, one for home, one for daycare, and one to carry around throughout the day.

If your child’s allergy is less severe, their allergist may hold off on prescribing an EpiPen until they reach the weight guidelines for an EpiPen Jr. – 33 pounds – but if it seems possible that they have a more severe allergy to fish, the allergist may prescribe an EpiPen Jr. anyway.

Whether your child’s doctor prescribes an EpiPen, or just recommends antihistamines in case of an allergy attack, it’s important to have whatever supplies are recommended on-hand at all times, and to make sure that all of your child’s caregivers know their allergy response plan.

  • Jordan C. Smallwood. “Fish Allergy.” KidsHealth. The Nemours Foundation, September 2015. Retrieved November 27 2017.
  • “Fish Allergy.” Food Allergy Research and Education. Food Allergy Research and Education. Retrieved November 27 2017.
  • “Fish Allergy: Potential Cross-Reactivity Between Fish.” American Academy of Allergy Asthma & Immunology. American Academy of Allergy, Asthma, & Immunology, October 23 2013. Retrieved November 27 2017. 

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