Fish allergy is more common in adults than in children. Fish allergy tends to be life long.
A child who is allergic to only one or two types of fish may sometimes be able eat other types of fish without an allergic reaction. Steam formed by cooking fish may cause allergic reactions in very sensitive children. This means the whole family may need to avoid eating fish or the fish may need to be cooked outside.
Allergy skin prick tests are helpful in the investigation of fish allergy however; some children with a positive allergy test will not necessarily have an allergic reaction after eating the fish. Sometimes it will be necessary to do a challenge with fish in hospital to prove a child will not react before eating fish at home. If a fish allergy is suspected you should not give your child fish unless advised to do so by your doctor.
What are the symptoms of fish allergy?
Reactions can range from mild to severe.
Mild to moderate reactions consist of any one or more of the following:
- hives or welts,
- swelling of the lips/face/eyes,
- tingling of the mouth,
- abdominal pain or vomiting.
Severe reactions (anaphylaxis) include one or more of the following:
- Difficulty/noisy breathing,
- swelling of the tongue,
- swelling or tightness in the throat,
- difficulty talking and or hoarse voice,
- wheeze or persistent cough,
- persistent dizziness or collapse, pale and floppy (in young children).
It is rare (but possible) for these symptoms to occur alone without hives and/or vomiting.
What is an Epipen or Anapen?
Epipens and Anapens are emergency devices called adrenaline autoinjectors that inject a dose of adrenaline into the muscle. They are used to treat severe reactions to nuts (anaphylaxis). The drug adrenaline reverses the severe allergic reaction and can be lifesaving.
Should my child carry an adrenaline autoinjector?
All allergists agree that children who have had a serious reaction to nuts with involvement of the breathing passages should have an adrenaline autoinjector. The need for other children to have an adrenalin autoinjector depends on a number of factors which should be discussed with your doctor. If you have an adrenaline autoinjector it is very important that you understand how and when to use it and that you have a written anaphylaxis action plan provided by your doctor.
What sorts of fish can my child be allergic to?
There are 2 main types of fish which can trigger allergic reactions:
- fish with backbones
- fish without a backbone often called seafood
Fish with backbones
From an allergy point of view, these fish may be divided into 6 groups:
Group 1 shark, flake and sweet william
Group 2 sardines, pilchards and anchovies
Group 3 salmon, pike and trout
Group 4 cod, hake and haddock
Group 5 tuna, mackerel, snapper, pink snapper, perch, barramundi, bream, flathead and
Group 6 sole, flounder, halibut
There are many thousands of different types of fish. The names given to fish can vary from place to place so make sure that the fish you buy is correctly named.
If your child is allergic to a fish in one of the groups it may be possible to find a fish in another group which does not cause an allergic reaction .Your doctor can sort this out with allergy skin tests using small pieces of the fresh fish followed by an oral challenge.
Fish without backbones (or Invertebrates)
- Crustaceans eg prawns, shrimps, lobster, crayfish, crab, yabbies, bugs
- Molluscs eg snails, abalone, mussels, clams, oysters, pipis, cockles
- Cephalopods eg octopus, cuttlefish, squid, calamari
- Gastropods eg sea slugs, garden slugs and snails
The allergens in invertebrates are not destroyed by cooking. If your child is allergic to any of these invertebrates, all invertebrates should be avoided. Children who are allergic to invertebrates may not be allergic to fish with backbones.
What foods have fish in them?
Fish is used in fish fingers, calamari rings, fish burgers and fish nuggets. It may be difficult to find out what type of fish is in a specific product and the fish used may vary from time to time.
Fish is part of many dishes, sauces, salad dressings, pastes and cracker biscuits.
Glucosamine supplements (used for arthritis) may be derived from crustaceans and should be avoided by people with allergies to crustaceans.
Possible foods with fish are:
· Frozen fish fingers
· Oyster sauce
· Crab sticks
· Fish sauce
· Prawn chips/crackers
· Salads eg Caesar salad
· Calamari rings
· Fish oils
· Seafood dips
· Worcester sauce
· Asian foods
· Fish stock
· Chinese dim sims
· Marinara dishes
Tips for avoiding fish and seafood
- Check the following for exposure to fish and seafood;
- BBQ surfaces which haven’t been cleaned after cooking fish
- Cooking oil in which fish has been previously cooked
- Batter which has had fish dipped into it
- Seafood platters which contain a mixture of fish and seafood
- Pet food that you child may access
Contacts for more information
- The Sydney Children’s Hospital Network website has more fact sheets on Allergies:
- Australian Society of Clinical Immunology and Allergy (ASCIA)
- FSANZ - Food Standards Australia and New Zealand for information on food labelling