Seafood allergy

What are the symptoms of seafood allergy?

Many allergic reactions to seafood are mild and consist of hives around the mouth
where seafood has touched the skin, or more generalised hives on other parts of the
body. Abdominal pain and vomiting after eating seafood may also occur as part of an
allergic reaction. More sensitive children can develop coughing, wheeze, difficulty
breathing or hoarseness of the voice due to an allergic reaction occurring in the throat
and breathing tubes. This reaction is known as anaphylaxis. In the most severe cases
collapse and loss of consciousness can occur.

Steam and vapours from seafood may cause wheezing or hayfever-like symptoms
(runny nose, sneezing, itchy eyes) in some children. These children do not appear to
be more at risk of anaphylaxis.

Not every adverse reaction to seafood is caused by an allergic reaction. Some

reactions can resemble allergic reactions but are actually caused by contaminants
present in the seafood.

What types of seafood are there?

There are 2 main groups of seafood which can trigger allergic reactions:
VERTEBRATES
These animals have bones and often scales – they are usually called ‘fish’
and include:
anchovies, barramundi, basa, bream, cod, flake, flathead, hake,
halibut, hoki, John Dory, ling, mackerel, perch, salmon, sardines,
snapper, sword fish, trout, tuna, whiting,
INVERTEBRATES
These animals do not have a backbone, and can be subdivided into four
groups:
Crustaceans e.g. prawns/shrimps, lobster, crayfish, crab, yabbies,
bugs
Molluscs e.g. snails, abalone, mussels, clams, oysters, pipis,
cockles
Cephalopods e.g. octopus, cuttlefish, squid, calamari
Gastropods e.g. sea slugs

The term "shellfish" is used to encompass "shelled" fish (such as oysters) as well as
crustaceans.

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This document was last reviewed on 10 July 2012
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The next date of review for this document is 10 July 2014
 Seafood allergy

How common is seafood allergy?

Fish allergy affects about 1 in 200 people while allergy to invertebrates is more
common affecting about 1% of the population. However, many parents delay feeding
their children invertebrates, so in younger children fish allergy is probably more
common than allergy to invertebrates.

Seafood allergy:
is more common in adults than children
is not as common as milk, egg or peanut allergy
tends to be lifelong

Are allergy tests helpful?

Allergy skin prick tests are helpful in the investigation of seafood allergy. However,
some patients with a positive allergy test will not necessarily get a reaction after
eating seafood. In some cases it will be necessary to perform a challenge with
seafood in hospital to prove a child will not react before eating the food at home. If a
seafood allergy is suspected you should not give your child seafood unless advised to
do so by your doctor.

Should my child avoid all types of fish?

A child who is allergic to only one or two types of seafood may sometimes be able to
eat other types of seafood without an allergic reaction. Other children however can be
allergic to many types of seafood.

In general, children with an allergy to any of the invertebrates:

are very likely to be allergic to other invertebrates. This is called cross-
reactivity and is more likely to happen with invertebrates than with fish.
Children allergic to one type of invertebrate should therefore avoid other
types too.
More than half of children who are allergic to invertebrates are able to eat
fish. Your doctor can advise you whether your child should avoid fish too.

Children with fish allergy:

Are often allergic to other fish types too.
Are often also allergic to invertebrates including prawn and crab.

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This document was last reviewed on 10 July 2012
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The next date of review for this document is 10 July 2014
 Seafood allergy

May be able to eat other fish which are less closely-related e.g. a child allergic to
tuna may be able to eat shark, also known as flake or Sweet William.
Some, but not all children allergic to fresh tuna or salmon can tolerate the fish
when canned – as the canning process alters the protein in the fish. You should
not give canned fish to your child unless your doctor has told you it is safe to do
so.

Your doctor will advise you as to what seafood should be avoided in your child’s diet.
There are many thousands of different fish. The names given to fish can vary from place
to place so make sure that the fish you buy is correctly named. If in doubt, it is safer not
to eat it!

This seems complicated. Can it be summarised?

In summary a child may be allergic to just one form of seafood or, since allergy can cross
react, to a number of different types of seafood. Your doctor can sort this out with allergy
skin tests using small pieces of the fresh fish followed by an oral challenge if necessary.

What other foods may contain fish or invertebrate

allergens?
Seafood is found in a variety of commonly eaten foods. It is part of many dishes, sauces,
salad dressings, pastes and some cracker biscuits. Seafood is processed into fish
fingers, calamari rings, fish burgers and fish nuggets. It may be difficult to find out
exactly what type of seafood is in a specific product and the seafood used in a particular
product may vary from time to time. Remember to check the food labels. Possible
sources of seafood are:
Salads eg Caesar salad Asian foods Fish stock
Oyster sauce Marinara dishes Seafood flavouring
Fish sauce Calamari rings Surimi
Fish oils Pet food Crab sticks
Seafood dips Worcester sauce Cuttlefish and squid ink
Prawn chips/crackers Frozen fish fingers Sushi
Some food supplements Some medicines

Written by:
The Departments of Allergy & Immunology and Nutrition and Dietetics, The Children’s
Hospital at Westmead and edited at Sydney Children’s Hospital, Randwick.

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This document was last reviewed on 10 July 2012
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The next date of review for this document is 10 July 2014