Reported fish allergy prevalence varies widely, with an estimated prevalence of 0.2% in the general population. Sensitization to fish can occur by ingestion, skin contact or inhalation. The manifestations can be IgE or non-IgE mediated. Several fish allergens have been identified, with parvalbumins being the major allergen in various species. Allergenicity varies among fish species and is affected by processing or preparation methods. Adverse reactions after eating fish are often claimed to be ‘allergy’ but could be a reaction to hidden food allergen, fish parasite, fish toxins or histamine in spoiled fish. Identifying such causes would allow free consumption of fish. Correct diagnosis of fish allergy, including the specific species, might provide the patient with safe alternatives. Patients have been generally advised for strict universal avoidance of fish. However, testing with various fish species or preparations might identify one or more forms that can be tolerated.