Fish Allergy: In Review Michael F. Sharp & Andreas L. Lopata # Springer Science+Business Media New York 2013 Abstract Globally, the rising consumption of fish and its derivatives, due to its nutritional value and divergence of international cuisines, has led to an increase in reports of adverse reactions to fish. Reactions to fish are not only medi- ated by the immune system causing allergies, but are often caused by various toxins and parasites including ciguatera and Anisakis. Allergic reactions to fish can be serious and life threatening and children usually do not outgrow this type of food allergy. The route of exposure is not only restricted to ingestion but include manual handling and inhalation of cooking vapors in the domestic and occupational environ- ment. Prevalence rates of self-reported fish allergy range from 0.2 to 2.29 % in the general population, but can reach up to 8 % among fish processing workers. Fish allergy seems to vary with geographical eating habits, type of fish processing, and fish species exposure. The major fish allergen character- ized is parvalbumin in addition to several less well-known allergens. This contemporary review discusses interesting and new findings in the area of fish allergy including demo- graphics, novel allergens identified, immunological mecha- nisms of sensitization, and innovative approaches in diagnosing and managing this life-long disease. Keywords Fish allergy . IgE antibody . Food allergen . Prevalence . Clinical symptoms Introduction Seafood plays an important role in human nutrition and health, but can provoke serious IgE antibody-mediated adverse re- actions in susceptible individuals. A marked increase in allergic diseases is occurring in most major industrialized countries. The World Allergy Organization reports that in 2008, 20–30 % of the world population was affected by allergy of some type. The seafood allergy and anaphylaxis epidemic is particularly serious. Seafood allergy, including shellfish and fish, is typically life-long affecting up to 5 % of all children and 2 % of all adults. While shellfish and fish allergy are often discussed concurrently, mostly likely due to culinary habits, the allergens causing allergic sensitization are entirely different and must be divided for a comprehensive review. Prevalence rates specifically to fish vary considerably between regions and among children and adults. This review compares the different prevalence rates of fish allergy and explores the possible underlying molecular and immunologi- cal causes, resulting in better diagnostic approaches for im- proved management of this life-long food allergy. Demographics and Prevalence Children Fish allergy has a significant adverse effect on anxiety and stress in the families of affected children. Parental recall of dietary advice is variable and many tend to impose more stringent dietary avoidance than that recommended. Despite this, subsequent accidental reactions are common and dem- onstrated in over 20 % of diagnosed children [1]. Thus, the avoidance of fish in children may be more difficult than often presumed. In Europe, most of the populations based prevalence studies come from Spain, Portugal, and the Scandinavian countries. In Norway, adverse food reactions were reported in a population-based study among 3,623 children and near- ly 3 % of all reactions were attributed to fish by the age of 2 years [2]. Thus, fish allergy in Norway is almost as common as allergy to egg among children, while fish allergy is more common in children from Finland [3]. A study from M. F. Sharp : A. L. Lopata (*) Molecular Immunology Group, Center of Biodiscovery and Molecular Development of Therapeutics, School of Pharmacy and Molecular Science, James Cook University, Townsville, Australia e-mail: andreas.lopata@jcu.edu.au Clinic Rev Allerg Immunol DOI 10.1007/s12016-013-8363-1