Sixth-grader Cameron Jean-Pierre was celebrating New Year’s Day of 2019 at his grandmother’s home in New York City. Cod was cooking on the stove, its smell wafting in the air when the 11-year-old arrived.

Cameron, who had a known fish allergy, started wheezing, and his father administered his asthma nebulizer used previously for his allergy attacks. The nebulizer was not successful, and Cameron couldn’t breathe in air. Cameron’s father, Steven, called 911, and Cameron was taken to a Brooklyn hospital, where he died (Bever, 2019; Sundby, 2019.) 

Eighteen-year-old Trinity College football player Avery Gilbert had a fish allergy. On August 10, 2022, his third day on campus, Avery consumed a meal labeled “grilled chicken, roasted potatoes, and veggies (contains no allergens)” in a dining hall area titled “The Zone: An Allergen-sensitive Area.” Sadly, the meal contained fish or was cross contaminated by fish, and Avery died from a severe allergic reaction.

Avery’s parents have sued the institution for Avery’s wrongful death based on three premises: food preparation allowed cross contact with allergens, “adequate and accurate warnings of food containing food allergens” were not present, and staff were not properly trained regarding cross contact (Mondello, 2023).

May these tragedies serve as reminders to food service staff that ingestion is not always the cause of food allergic reactions and that proper labeling, food allergy staff training, and completely allergen-free food preparation areas and equipment are imperative for food allergy prevention.

Fish Allergy Allergic Reaction Symptoms and Causes

Some fish allergy reactions involve inhalation of fumes; other causes include inhaling dust containing dried fish particles, ingestion, or contact with skin. Reactions can include: 

• swelling of the lips
• mouth and throat tingling
• skin rash
• hives
• nausea
• indigestion
• stomach cramps
• diarrhea
• vomiting
• congestion
• runny nose
• sneezing
• headache
• throat tightening
• wheezing
• hoarseness
• decrease in blood pressure causing lightheadedness or loss of consciousness
• asthma
• anaphylaxis

(Better Health, 2023; Nemours Kids Health, 2023)

The major allergenic protein that has been identified in fish is parvalbumin, which is to blame for over 95 percent of fish allergies (Sharp & Lopata, 2014; Subham et al., 2023). Studies prove that this protein causes a reaction for the most commonly eaten species, which include carp, mackerel, salmon, and tuna (Subham, et al., 2023).

Correcting Erroneous Theories — Which Fish Is Safe?

According to Singapore-based scientist, Thimo Ruethers, PhD, canned fish, such as tuna, is processed with elevated heat levels. Because of this, some believe it is safe for consumption for those with fish allergies. However, Ruethers and his team of scientists have debunked this theory. They say, “Contrary to common belief, we found that although allergens (allergy-triggering fish proteins) were markedly reduced in canned fish, they were not destroyed during the heating process. The canned product remained dangerous to some people with fish allergies.”

These findings were the result of testing 17 canned fish products sold in Australia, from nine different manufacturers (James Cook University, 2023).

Another false belief is that a person affected by a fish allergy is likely only allergic to the particular fish species that triggered a reaction. While a person can be allergic to only one type of fish, according to food allergy expert Scott Sicherer, MD, an individual with any fin fish allergy may be allergic to other types of fish up to 50 percent of the time (Sicherer, 2017.) A person may also only be allergic to some parts of fish but not others. Because of these findings, individuals with a known fish allergy are strongly advised to avoid all parts of freshwater and seawater fish of any type (Sicherer, 2017).

A Record Increase in Fish Consumption

Fish consumption has risen worldwide in the last few years due to its popularity in international cuisine and its nutritional value. National Fisheries Institute’s top 10 list of seafood consumption in 2021 indicated that Americans consumed a record-breaking amount of fish per capita.

Salmon was the most consumed fish in America, at 3.38 pounds consumed per capita, while canned tuna came in second, with 1.90 pounds. Tilapia was third place in US fish consumption with 1.04 pounds consumed per capita (Chase, 2023; Mossler, 2020).

An Increase in Fish Allergic Reactions

A result of the increased consumption of fish is an uptick in allergic reactions. It is estimated that 1 percent of individuals in the US — over 3 million (FARE, 2023) — and up to 2.39 percent of individuals globally have a fish allergy. However, that number increases to 8 percent of fish-processing employees, either by handling or ingesting the fumes of fish (Jiang & Rao, 2021). Its prevalence has been calculated as high as 7 percent in pediatric populations in some countries (Buyuktiryaki et al., 2021). Approximately 40 percent of all individuals with fish allergy experience their first allergic reactions as adults (FARE, 2023).

One of the Most Potent Food Allergies

More adolescents and adults have fish allergies than do younger children (Better Health, 2023). In most cases, an affected child or teen does not outgrow fish allergy but continues into adulthood with life-threatening symptoms. Alarmingly, extremely low amounts — mere milligrams of fish — are enough to provoke allergic symptoms in hypersensitive individuals (Kuehn et al., 2014).

Fish allergy proliferates throughout multiple species and throughout one’s lifetime. Because a minute portion is potent, ensure your fish allergic campers’ safety by eliminating any fish from your menu for the camp sessions they attend. To help you determine any fish-related ingredients, refer to the following fish allergy avoidance list.

Fish Allergy Avoidance List

US labeling laws mandate that the type of fish be listed on the labels of foods containing fish ingredients (Sicherer, 2017).
There are more than 20,000 species of fish. Although this is not a complete list, allergic reactions have been commonly reported to:

• Anchovies
• Barramundi
• Bass
• Catfish
• Caviar
• Cod
• Flounder
• Grouper
• Haddock
• Hake
• Halibut
• Herring
• Mackerel
• Mahi mahi
• Monkfish
• Orange roughy
• Perch
• Pike
• Pollock
• Salmon
• Sardines
• Scrod
• Sole
• Smelt
• Snapper
• Swordfish
• Tilapia
• Triggerfish
• Trout
• Tuna
• Whitefish
• Whiting
• Other finfish

Also avoid these fish products:

• Fish flavoring
• Fish gelatin (made from the skin and bones of fish)
• Fish oil
• Fish oil supplements such as Omega-3 (check with your doctor)
• Fish sticks (some people make the mistake of thinking these don’t contain real fish)
• Fish stock
• Gumbo
• Seafood flavorings

Some unexpected sources of fish:

• Barbecue sauce
• Bouillabaisse
• Caesar salad and Caesar dressing
• Caponata, a Sicilian eggplant relish
• Dishes often derived from fish-based sauces, such as oyster sauce
• Imitation or artificial fish or shellfish (e.g., surimi, also known as “sea legs” or “sea sticks”)
• Seafood soups, stews, and broths
• Sushi
• Spreads like taramasalata, a Greek dip made from cod, carp, or gray mullet roe/tarama (eggs)
• Worcestershire sauce and some other steak sauces
• Certain international cuisines, especially African, Chinese, Indonesian, Thai, and Vietnamese, can contain hidden sources of fish (e.g., kimchi made with fish sauce) or a high risk of cross contact, even if you order a fish-free dish
• Fish proteins survive in high levels of heat, so any oil used to fry fish would likely be a cross contaminant to other foods fried afterward

May contain fish:

• Bonito broth
• Combination foods such as fried rice, spring rolls, and paella
• Deli meats
• Dips, spreads, and salad dressings
• Foods containing gelatin, such as hot dogs or marshmallows
• Fried foods from contaminated frying oil
• Gelatin, kosher gelatin, or isinglass
• Gumbo
• Imitation crab
• Surimi

(FARE, 2023; Gupta, 2021) 

References

• Better Health. (2021). Shellfish and fish allergies. betterhealth.vic.gov.au/health/conditionsandtreatments/shellfish-and-fish-allergies
• Bever, L. (2019, January 3). Child with food allergy dies after inhaling fish fumes, father says. Washington Post. washingtonpost.com/health/2019/01/03/child-with-food-allergy-dies-after-inhaling-fish-fumes-father-says/
• Buyuktiryaki, B., Masini, M., Mori, F., Barni, S., Liccioli, G., Sarti, L., Lodi, L., Giovanni, M., du Toit, G., Lopata, A. L., & Marques-Mejias, M. A. (2021, January 18). IgE-mediated fish allergy in children. Medicina. mdpi.com/1648-9144/57/1/76
• Chase, C. (2023, June 7). Americans consumed a record amount of seafood in 2021. seafoodsource.com/news/foodservice-retail/americans-consumed-a-record-amount-of-seafood-in-2021
• Dietitians of Canada. (2021, October 28). What do I need to know about seafood and fish allergies. UnlockFood.ca. unlockfood.ca/en/Articles/Allergies-and-Intolerances/What-Do-I-Need-to-Know-About-Seafood-and-Fish-Allergies.aspx
• Food Allergy Research & Education. (2023). What is fish allergy. FARE. foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/fish
• Gupta, R. (2021). Food without fear. New York, NY: Hachette Book Group.
• James Cook University. (2023, October 2). Canned fish can still trigger allergic reactions, says study. Medical Xpress. medicalxpress.com/news/2023-10-canned-fish-trigger-allergic-reactions.html
• Jiang, X. & Rao, Q. (2021, April 28). Effect of processing on fish protein antigenicity and allergenicity. MDPI. mdpi.com/2304-8158/10/5/969
• Kuehn, A., Swoboda, I., Arumugam, K., Hilger, C., & Hentges, F. (2014, February 13). Fish allergens at a glance: Variable allergenicity of parvalbumins, the major fish allergens. Frontiers in Immunology. frontiersin.org/articles/10.3389/fimmu.2014.00179/full
• Mossler, M. 2020, July 27). Seafood consumption in the US (pre-pandemic). Sustainable Fisheries. sustainablefisheries-uw.org/seafood-consumption-statistics
• Mondello, W. (2023, February 16). College sued after freshman suffers fatal food allergic reaction. Allergic Living. allergicliving.com/2023/02/16/college-sued-after-freshman-suffers-fatal-food-allergic-reaction/
• The Nemours Foundation. (2023) Fish allergy. KidsHealth. kidshealth.org/en/parents/fish-allergy.html
• Sicherer, S. (2017). Food allergies: A complete guide for eating when your life depends on it. Baltimore, MD: Johns Hopkins University Press.
• Sharp, M. & Lopata, A. (2014, June). Fish allergy: In review. Clinical Reviews in Allergy and Immunology. pubmed.ncbi.nlm.nih.gov/23440653/
• Subham, M., Horka, P., Zdendova, K., & Cermakova, E. (2023, January 14). Parvalbumin: A major fish allergen and a forensically relevant marker. Genes, 14(1), 223. doi.org/10.3390/genes14010223
• Sundby, A. (2019, January 3). Boy with fish allergy dies after smelling fish cooking at New Year’s Day gathering. CBS. Retrieved from cbsnews.com/news/boy-dies-after-smelling-fish-allergy-cooking-new-years-day-gathering/

Kimberly Whiteside Truitt is a former food service manager at Camp Gilmont and Camp Zephyr and has served on Camping Magazine’s Editorial Advisory Committee. Kimberly was a presenter at the  2018, 2020, and 2023 North American Food Service and Maintenance Conferences.