In 2019, when Bethenny Frankel, The Real Housewives of New York City star drank soup containing fish on an airplane, she had a severe reaction. Although the actor was given the required medical attention, her doctor later revealed that a moment’s delay could’ve proved fatal, thanks to fish allergy.
Finned fish allergies may not be as common as other food or shellfish allergies, but they are just as serious. This explains why The Food Allergen Labelling and Consumer Protection Act of 2004 in the US mandates manufacturers of packaged food products in the country to mention fish and fish products as one of the eight allergens on the ingredient label with many other countries following suit.
Shabbir Calcuttawala can’t agree more. The businessman from Kochi, India has been dealing with a fish allergy he accidentally discovered five years ago and hopes for more stringent food packaging laws back home. “I dread going through the same trauma I experienced after a friend’s party in 2017.” Calcuttawala developed a nasty rash on his face and experienced breathlessness after binging on barbecued fish at the party. However, what bothers him more is that his allergy has been a bolt from the blue especially since he doesn’t have any memory of discomfort after eating fish before that.
Something fishy about fish allergy
The American College of Allergy, Asthma, and Immunology says that a fish allergy does not become apparent until adulthood, unlike other food allergies.
Dr D M Mahajan, senior consultant, dermatology, Indraprastha Apollo Hospital, New Delhi, says the allergy can develop at any age and people who have eaten fish in the past can develop the allergy later.
Another interesting fact he shares is that allergic reactions aren’t restricted to eating fish alone. People can react to even touching fish or breathing in vapours from cooking fish.
Soumita Biswas, chief nutritionist, Aster RV Hospital, Bengaluru, has more surprising information. She says symptoms can also develop by touching utensils that are used to prepare fish.
Dr Suneela Nayak, an allergist from Bengaluru confirms that the reactions, as some people assume, are not psychological. Microscopic parts of the protein that causes fish allergy can be present in the fumes when fish is being cooked or on the utensils either due to cooking or cross-contamination. “These particles can enter through the mucous membrane or the skin of a person who is sensitive to them and trigger symptoms,” she explains.
What causes fish allergy?
“Contrary to the common belief, people with a fish allergy don’t have a weakened immune system,” clarifies Dr Nayak. “It only reacts differently to the allergen.”
Explaining the process, Dr Mahajan says, the body’s immune system, which normally fights infections, overreacts to parvalbumin or other allergens like gelatin in the fish. Parvalbumin is a protein in the white muscle of fish.
“Every time the person eats (or, in some cases, handles or breathes in) fish, the body perceives the harmless protein as an invader and releases a chemical called histamine. Histamine produces antibodies that attack the allergens and cause the symptoms,” he says.
Dr Mahajan also adds that since parvalbumin may be present in many fish, some people who are allergic to one type of fish may be allergic to others as well.
Calcuttawala develops a runny nose and rash every time he eats a dish with fish sauces. But the symptoms are mild, and he wonders if he needs to rush to the doctor every single time.
Symptoms that must not be ignored
According to Biswas, the mild symptoms are hives (skin rash) nausea, stomach cramps, indigestion, vomiting, and/or diarrhoea, stuffy or runny nose, sneezing, headaches and breathlessness.
Symptoms can appear within half an hour, two hours or even forty-eight hours after fish consumption, says Dr Nayak, who advises people to consult a doctor to confirm if the symptoms are due to fish allergy.
Dr Mahajan warns that if the symptoms are ignored, it can lead to severe skin rashes, respiratory symptoms, gastrointestinal distress and anaphylaxis.
It is anaphylaxis that people with a fish allergy need to be most careful of, says Dr Nayak. “Although it is an uncommon and a very individualised allergic reaction, it is sudden and potentially life-threatening as it impairs breathing due to the swelling of the lips, tongue and airway,” she adds.
Confirming fish allergy
Dr Nayak has observed that most people assume they have a fish allergy which makes their lives restrictive. “A person may develop symptoms after eating fish and presume they are allergic, but it may happen that the dish they consumed had a different allergen and the person may be reacting to that instead of fish,” she says.
Hence the allergist insists on consulting a doctor for proper guidance and confirmation.
According to her, a fish allergy is confirmed with:
- A detailed history to ascertain the cause by excluding food poisoning and other conditions
- A skin prick and blood test to check for allergic reactions
- An oral food challenge test if the above two are inconclusive
The tests are explained here. (https://www.happiesthealth.com/articles/allergies/food-allergies-tests-diagnosis-treatment).
Because the response to an oral food challenge may be severe, it is only performed in the presence and under the direction of a medical professional who can deliver emergency treatment if needed.
Coping with the condition
Dr Nayak suggests playing it safe. If fish allergy is confirmed, it’s better to avoid fish and its products altogether. This includes all sauces, dressings, condiments and food prepared with fish or their by-products.
Dr Mahajan says if the allergy symptoms are mild, one can often treat them with over-the-counter oral antihistamine pills after consultation with the doctor. To deal with anaphylaxis, he advises people to carry adrenaline or a single-use, pre-filled epinephrine auto-injector, which one can self-inject into the thigh in case of an emergency.
Dr Nayak says the auto-injector is vital because reaching the doctor sometimes may involve a delay and can prove to be fatal.
“Adrenaline is a must in the treatment of anaphylaxis. Unfortunately, many people are given other drugs due to a lack of awareness of the condition,” adds Dr Nayak who hopes for better awareness and a better quality of life for people who grapple with this lifelong condition.
As for Calcuttawala, the challenge to avoid the staple food of his region is real but not more than the threat it poses to his health and well-being.