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Wai Sze Tong,1,* Agatha WT Yuen,1,* Christine YY Wai,2 Nicki YH Leung,2 Ka Hou Chu,1 Patrick SC Leung3 1School of Life Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China; 2Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China; 3Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, University of California Davis, Davis, CA, USA *These authors contributed equally to this work Abstract: Seafood allergy is a hypersensitive disorder with increasing prevalence worldwide. Effective and accurate diagnostic workup for seafood allergy is essential for clinicians and patients. Parvalbumin and tropomyosin are the most common fish and shellfish allergens, respectively. The diagnosis of seafood allergies is complicated by cross-reactivity among fish allergens and between shellfish allergens and other arthropods. Current clinical diagnosis of seafood allergy is a complex algorithm that includes clinical assessment, skin prick test, specific IgE measurement, and oral food challenges. Emerging diagnostic strategies, such as component-resolved diagnosis (CRD), which uses single allergenic components for assessment of epitope specific IgE, can provide critical information in predicting individualized sensitization patterns and risk of severe allergic reactions. Further understanding of the molecular identities and characteristics of seafood allergens can advance the development of CRD and lead to more precise diagnosis and improved clinical management of seafood allergies. Keywords: skin prick test, DBPCFC, component-resolved diagnosis, immunoCAP, ISAC