Living with a fish allergy is not always as straight forward as it seems. There are many foods that obviously contain fish, but also quite a few that use fish ingredients that you wouldn’t expect. Discover some of the suprising things that have fish ingredients, including non-food products to watch out for.
What is a fish allergy?
Food allergies occur when the immune system mistakenly reacts to proteins in food. For fish, this reaction is usually to a protein called parvalbumin. An allergic reaction to fish can be milk, moderate or severe (including life-threatening anaphylaxis).
When talking about fish allergy, this is usually limited to “finned fish” which have a back bone, like salmon, cod, mackerel, sardines, herring, anchovies, tuna, trout, haddock, eels and rays. Other types of seafood like crustaceans (prawns, lobster, crab etc) or molluscs (oysters, mussels, squid etc) are treated as separate allergens.
Fish allergies are more common in teenagers and adults than young children, and in parts of the world where fish is an important part of the diet (such as Scandanavia). We manage a fish allergy that developed much later than other food allergies like egg and peanut.
Airborne reactions to fish are a possibility, becuase fish proteins can be released into the air when cooking. We have experienced this first hand when cooking fresh fish at home.
Can you be allergic to some fish and not others?
If you have a confirmed fish allergy, you should generally avoid all types of fish (unless your allergist gives you different advice).
Usually people with an allergy to one type of fish will be allergic to most other types of fish. However, sometimes people may be able to safely consume certain types of fish and not others. We have a family member with a fish allergy who has reacted to some types of fish and tested positive on allergy testing to many more. Under the guidance of our allergist, we are working through some oral food challenges to see if some types of fish are safe.
Fish allergy food labelling
Food allergen labelling laws vary in different countries, but fish allergy is something most countries have in common. Fish is one of the top allergens and must be listed on food ingredient labels in Australia with a statement that the product “contains fish“. It is also one of the top allergens in the UK and the US and is considered a “priority” allergen in Canada.
Foods with fish ingredients
Fish remains a popular food around the world. It’s widely eaten in Scandanavian counteries, as part of a Mediterranean diet, and features prominantely in Asian food. It is also becoming increasingly popular for health conscious people, including those who follow a pescatarian diet (who eat fish, but not meat).
Sometimes the presence of fish is obvious, like whole baked fish, fish fillets or a dish where the fish is easily recognisable, such as in Japanese sushi and sashimi.
However, often it it is hard to tell if a food contains fish. Especially if it is used in a stock, sauce, paste or to add flavour.
Fish is often used in:
- Asian dishes, soups, stir fries and curries (often made with fish sauce)
- bread and breadcrumbs
- Caeser salad (watch for anchovies in the dressing as well as the salad)
- dips – like Taramasalata, a Greek dip made with cured fish roe
- Japanese food – including sushi, sashimi, noodles, soups (like Miso soup and other dishes made with bonito flakes or dashi) and sauces
- marinades, sauces, dressings and condiments (which may contain anchovies or fish based stock)
- pizza and pasta dishes (tuna or anchovies)
- grilled meats like steak and hamburgers (whch might use Worcestershire sauce to flavour)
Like any other food allergy, you should always read the ingredients carefully to check for fish ingredients. We do this 3 times: once before buying, again when putting away, and a third time before eating.
Fish allergy cross contact
Living with a fish allergy means being careful about cross contact (sometimes called cross contamination) when foods are prepared, cooked or stored. For example, fish proteins can come into contact with food when cooking on a barbecue that hasn’t been cleaned, or if you are ordering a pizza where there are anchovies or other fish ingredients in the preparation area. It can also be a problem where foods are cooked in the same deep fryer.
When eating out, always declare your allergy. Ask that your food is prepared with clean utensils and a separate cooking pan.
If you have an EpiPen or other epinephrine device, always carry two with you together with a copy of your Action Plan.
Unusual places to find fish as an ingredient
Even if you are an expert at reading food labels and understanding foods fish might be in, it can turn up in some very unexpected places.
Foods with worcestershire sauce
Worcestershire sauce contains fish (anchovies). This should be clearly listed as a fish allergen on the ingredient label. However, when it comes to home cooked or restaurant meals, Worcestershire sauce can be a sneaky way for fish to end up in a meal when you wouldn’t expect it to.
Many people like to add a dash of Worcestershire sauce to dishes like bolognese sauce for pasta or soups and stews for added flavour. Worcerstershire sauce is also used in marinades for steak, added to burgers or to sauces and gravy. It’s even used to flavour devilled eggs or omlettes and is an essential ingredient in a Bloody Mary cocktail.
Foods with fish sauce
Popular in South East Asian Countries like Thiland and Vietnam, fish sauce is a very strong smelling ingredient made from fermented fish, salt, and water. Fish sauce adds a “umami” or savoury taste to dishes, including dishes that might not obviously contain fish.
Watch out for fish sauce in marinades for meat, soups and stir fries. It’s sometimes used in Western dishes too, including salads, bolognese pasta sauce or even to add flavour to vegetables.
One of our local sushi restaurants has a note on the table to alert customers to the fact that their soy sauce contains fish.
Bread and other foods with added Omega-3
Omega-3 is an important group of polyunsatured fats that are important for health and preventing disease. Health organizations like the Australian Heart Foundation recommend that healthy adults include at least 250–500 mg of 2 Omega 3 fatty acids called DHA and EPA in their diet each day.
Because of this, some companies fortify products like sliced bread with Omega-3 sourced from fish (such as tuna oil). Make sure to carefully check ingredients for any products marketed as having extra Omega-3.
Most Omega-3 supplements are made with fish oil as well. Fortunately there are alternative sources of Omega-3 fatty acids you can include in your diet if you can’t have fish, including plant based products and vegan supplements.
Crocodile or alligator meat
While it technically isn’t fish, crocodile or alligator meat actually contains similar food proteins to fish. This means that a number of people who are allergic to fish will also be allergic to crocodile or alligator meat as well.
Wine
Fish is sometimes used in wine-making. Some wines are clarified using isinglass (derived from fish bladder). In Australia, producers aren’t required to label wines clarified with isinglass as containing fish as the risk to people with fish allergy is considered low. If you have a severe fish allergy, ask your allergy specialist whether you need to avoid wines which use fish products in the production process. Vegan-certified wines are a safe alternative.
Pet food
You’re probably not going to eat it, but it’s definitely worth taking care when handling pet food with a fish allergy. The obvious source is cat food, which is often fish based. However there can be fish in many other sorts of pet foods. We use an insect-based poweder supplement for our birds that also contains fish.
Fish ingredients in cosmetics and beauty products
Some beauty products use fish collagen, extracted from the skin, bones and fins of fish. Fish collagen might be used in anti-aging creams and serums.
More about fish allergies
If you have a fish allergy, find out more about how you can include fish-free Omega-3 fatty acids in your diet.
For more about fish allergies, see the following resources we’ve referred to in this post:
You can also download a handy fish allergy card from Allergy and Anaphylaxis Australia which lists food ingredients to watch out for.
If you’ve been prescribed an EpiPen or other epinephrine device for a serious fish allergy, you may also like to read our posts:
- Making friends with your EpiPen
- Our pick of the latest Allergy Medical Alert IDs
- Best EpiPen bag tag styles for all ages
- Easy way to remember your EpiPens, every time
And don’t forget to subscribe for more practical allergy tips and food allergy friendly recipes, which are all fish free.
*Disclaimer: Allergy Spot does not provide medical advice. You should always consult a suitably qualified medical practitioner in respect of your own medical conditions, symptoms or concerns. See our Website Terms for more details.
