General Information

  • Reactions to food are common and can be divided into two categories, those caused by food allergy and all other reactions
  • Food allergies develop when the body’s immune system has an abnormal reaction to one or more proteins in a food that can lead to serious allergic reactions
  • Other food reactions are not caused by the immune system but can cause unpleasant symptoms (examples include lactose intolerance, heartburn, food poisoning, and sensitivities)
  • Fish allergy is one of the most common food allergies

Fish Avoidance

  • Tell anyone with regular contact with you or your child about the allergy and avoidance of fish
  • Read labels every time you buy something. Manufacturers can change products at any time
  • Be aware of cross contamination (transfer of fish to a food that does not normally have fish as an ingredient)
  • Very sensitive people can react if they are close to where fish is being cooked or fried
  • About 30 to 50% of people with fish allergy will have reactions to more than one type of fish
  • Only 10% of people with fish allergy have allergies to shellfish (being allergic to fish does not always mean avoiding shellfish as well)
  • Some common fish include:
    • Anchovy
    • Hake
    • Sardine
    • Bass
    • Halibut
    • Shark
    • Bluefish
    • Herring
    • Smelt
    • Carp
    • Mackerel
    • Snapper
    • Catfish / mud cat
    • Mahi - mahi
    • Sole
    • Char
    • Marlin
    • Sturgeon
    • Cod
    • Monkfish / angler
    • Swordfish
    • Eel
    • Pickerel / dore
    • Tilapia
    • Flounder
    • Pike
    • Trout
    • Grouper
    • Pollock
    • Tuna/albacore/bonito
    • Haddock
    • Salmon
    • Turbot
  • Some food that contain or may contain fish:
    • Barbecue sauce
    • Gelatin
    • Sauce
    • Caesar salad dressing
    • Hot dogs
    • Soups
    • Deli meat
    • Imitation crab / lobster
    • Spring rolls
    • Dips
    • Marshmallows
    • Sushi
    • Fish mixtures
    • Paella
    • Tarama
    • Fried rice
    • Pizza toppings
    • Worcestersire sauce
    • Garnishes
    • Salad dressing
    • Wine / beer fining agent

Allergic Reactions

  • Symptoms often occur within minutes up to 2 hours of exposure to fish
  • Outside Symptoms
    • Face: Redness, itchy eyes / nose, swelling
    • Skin: Itching, redness, hives, swelling
  • Inside Symptoms
    • Face: Swelling lips and tongue, itchy mouth
    • Throat: Itching, tightness, hoarse voice, cough
    • Lungs: Trouble breathing, shortness of breath
    • Stomach: Vomiting, nausea, stomach pain, diarrhea
    • General: Dizzy, unsteady, drowsy, fainting
  • Not every reaction will look the same, a person can have different symptoms each time
  • Symptoms range from mild to life threatening, there is no way to predict if the reaction will be mild or severe
  • Anaphylaxis is a severe life threatening reaction with more than one body system affected (skin, breathing, stomach, general) and can occur WITHOUT skin symptoms such as hives

Treatment of Reactions

  • Antihistamines such as Benadryl will NOT stop severe reactions
  • An epinephrine auto injector such as Allerject or EpiPen MUST be available at all times
  • If you are visiting an area without access to a hospital you should have 2 auto injectors available
  • A medical identification device such a Medical Alert bracelet should be worn to outline the food allergy and that an epinephrine auto injector is carried
  • Give epinephrine in the outer thigh if there are any of the following symptoms (listed in the table on the previous page)
    • General symptoms
    • Severe outside symptoms
    • Any inside symptoms
    • If you are in doubt, give the epinephrine
    • After epinephrine is given
    • Lie down / lie your child down
    • Call local emergency service and tell them someone is having an allergic reaction
    • If the reaction continues or worsens, give a second dose of epinephrine in 5 - 15 minutes (there is only 1 dose of epinephrine in each auto injector, a second dose requires a new auto-injector)
    • Go to the nearest emergency room even if the symptoms are gone because the reaction can worsen or come back
    • Stay in the hospital for at least 4 - 6 hours of observation

Outcomes for Fish Allergic Patients

  • The majority of people do not outgrow the fish allergy
  • Repeat skin testing and blood work every 1 - 2 years will help determine if the allergy is outgrown
  • An oral food challenge (eating fish in small steps ONLY in the doctors office) will be offered if your doctor feels it is safe
  • Fish products should NEVER be tried outside of a doctors office to see if the allergy is outgrown

Additional information: www.anaphylaxis.ca or www.foodallergy.org