• Betul Buyuktiryaki, Marzio Masini, Francesca Mori, Simona Barni, Giulia Liccioli, Lucrezia Sarti, Lorenzo Lodi, Mattia Giovannini, George du Toit, Andreas Ludwig Lopata, and Maria Andreina Marques-Mejias.
• Division of Pediatric Allergy, Koc University Hospital, 34010 Istanbul, Turkey.
• Medicina (Kaunas). 2021 Jan 18; 57 (1).

AbstractFish allergy constitutes a severe problem worldwide. Its prevalence has been calculated as high as 7% in paediatric populations, and in many cases, it persists into adulthood with life-threatening signs and symptoms. The following review focuses on the epidemiology of Immunoglobulin E (IgE)-mediated fish allergy, its pathogenesis, clinical manifestations, and a thorough approach to diagnosis and management in the paediatric population. The traditional approach for managing fish allergy is avoidance and rescue medication for accidental exposures. Food avoidance poses many obstacles and is not easily maintained. In the specific case of fish, food is also not the only source of allergens; aerosolisation of fish proteins when cooking is a common source of highly allergenic parvalbumin, and elimination diets cannot prevent these contacts. Novel management approaches based on immunomodulation are a promising strategy for the future of these patients.

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