Fish allergy facing the Blue Transformation: gaps and opportunities

To cope with the impacts of climate change and the expected food demand of a growing population, FAO has launched a Blue Transformation program aiming the expansion and intensification of sustainable aquaculture, the effective management of all fisheries and the upgrade of value chains. Despite its well-known unique nutritional value, fish is one the Big Nine allergenic foods and provokes both IgE-mediated and non-IgE mediated allergies that affect at least 25 million people. Fish allergy management has relied on fish extensive exclusion diets and prevention of accidental exposures, being oral immunotherapy exceptional. However, the different phenotypes of fish allergic patients have shown several tolerance opportunities that must be taken into account in the FAO roadmap. In this review, we briefly described key features of fish as a source of food allergens, analyzed its production and processing trends and underline the opportunities and challenges to tackle the burden, the allergenicity modulation and bioaccessibility of fish allergens under the Blue Transformation goals.