• Carla Mastrorilli, Stefania Arasi, Simona Barni, Davide Caimmi, Fernanda Chiera, Pasquale Comberiati, Giulio Dinardo, Arianna Giannetti, Marco Gismondi, Serena Gracci, Francesco Paravati, Umberto Pelosi, Miraglia Del GiudiceMicheleM0000-0002-8369-5957Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy., Roberto Bernardini, and Luca Pecoraro.
• Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy.
• Medicina (Kaunas). 2023 Sep 12; 59 (9).

AbstractFish is one of the "big nine" foods triggering allergic reactions. For this reason, fish allergens must be accurately specified on food labels. Fish allergy affects less than 1% of the world population, but a higher prevalence is observed in pediatric cohorts, up to 7%. Parvalbumin is the main fish allergen found in the muscles. In childhood, sensitization to fish allergens occurs most frequently through the ingestion of fish, rarely transcutaneously or by inhalation. Fish allergy symptoms usually appear within two hours of the allergen contact. The diagnosis begins with the collection of the history. If it is suggestive of fish allergy, prick tests or the measurement of serum-specific IgE should be performed to confirm the suspicion. The oral food challenge is the gold standard for the diagnosis. It is not recommended in case of a severe allergic reaction. It is important to make a differential diagnosis with anisakiasis or scombroid poisoning, which have overlapping clinical features but differ in pathogenesis. Traditionally, managing fish allergy involves avoiding the triggering species (sometimes all bony fish species) and requires an action plan for accidental exposures. The present review will analyze IgE- and non-IgE-mediated fish allergy in children from epidemiology, pathogenesis to clinical features. Moreover, clinical management will be addressed with a particular focus on potential nutritional deficiencies.

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