Fish is one of eight foods that can cause severe allergic reactions. The growing consumption of fish and fish derivatives contributes to an increase in the incidence of fish allergies. Distinct regional variations in fish allergies are evident with higher prevalence rates observed in coastal countries, which may be related to the high consumption of local fish in these regions. The diagnostic methods of fish allergies include in vivo and in vitro detection, and the skin prick test is one of the most common screening methods. To date, several fish allergens have been identified, including parvalbumin, enolase, aldolase, collagen, and other allergens. Despite the homologous structure of parvalbumin from different fish species, variations in the IgE epitope may be one of the reasons leading to the complexity of fish allergies. To further understand the mechanisms of fish allergies, this review summarizes the recent literature and focuses on the clinical characteristics, mechanism, allergens, epitopes, and cross-reactivity.