Seafood plays an important role in human nutrition and health. A good patient workup and sensitive diagnostic analysis of IgE antibody reactivity can distinguish between a true seafood allergy and other adverse reactions generated by toxins or parasites contaminating ingested seafood. The 2 most important seafood groupings include the fish and shellfish. Shellfish, in the context of seafood consumption, constitutes a diverse group of species subdivided into crustaceans and mollusks. The prevalence of shellfish allergy seems to be higher than that of fish allergy, with an estimate of up to 3% in the adult population and fin fish allergy prevalence of approximately 1%. Clinical evaluation of the seafood-allergic patient involves obtaining a detailed history and obtaining in vivo and/or in vitro testing with careful interpretation of results with consideration of cross-reactivity features of the major allergens. Oral food challenge is useful not only for the diagnosis but also for avoiding unnecessary dietary restrictions. In this review, we highlight some of the recent reports to provide solid clinical and laboratory tools for the differentiation of fish allergy from shellfish allergy, enabling best treatment and management of these patients.
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