We evaluated the clinical characteristics found in 29 children who showed allergic symptoms after direct and/or indirect contact with fish, from 197 children diagnosed with IgE-mediated fish hypersensitivity. Allergic reactions to fish through ingestion began in most patients (79%) within the first 24 months of life. All the patients showed cutaneous symptoms, either alone or associated with other clinical manifestations. Whiff and hake were the species more frequently implicated in eliciting clinical manifestations upon ingestion. After diagnosis, all patients were placed on a strict fish avoidance diet. During this period of avoidance, 29 patients reported allergic reactions (mean age 5 years, 6 months; SD 4 years, 2 months) after incidental skin contact with fish. Clinical manifestations after touching fish were only cutaneous in 28 of the 29 studied patients. One showed local urticaria with wheezing. The majority reported two or more episodes. Incidental skin contact with fish could play an important role in accidental encounters with fish particles in children on a fish avoidance diet for fish IgE-mediated hypersensitivity. Such exposures could result in immunologic immediate contact reactions and in some cases could lead to systemic reactions (contact urticaria syndrome).