| Scombroid food poisoning | |
|---|---|
| Other names | Scombrotoxin fish poisoning, scombroid syndrome,[1] scombroid,[2] histamine fish poisoning,[1] scombroid poisoning[3] |
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| Histamine | |
| Specialty | Emergency medicine |
| Symptoms | Flushed skin, headache, itchiness, blurred vision, abdominal cramps, diarrhea[2] |
| Usual onset | After 10 to 60 min[2] |
| Duration | Up to 2 days[2] |
| Causes | Consumption of fish high inhistamine due to improper processing[2] |
| Risk factors | Tuna,mackerel,mahi mahi,sardine,anchovy,herring,bluefish,amberjack,marlin.[2] |
| Diagnostic method | Typically based on symptoms, bloodtryptase[2][1] |
| Differential diagnosis | Allergic reaction,[2]fish allergy[1] |
| Treatment | Antihistamines,epinephrine[2][3] |
| Frequency | Relatively common[2] |
| Deaths | Very rare[3] |
Scombroid food poisoning, also known as simplyscombroid, is afoodborne illness that typically results from eating spoiled fish.[2][4] Symptoms may includeflushed skin,sweating,headache,itchiness,blurred vision,abdominal cramps anddiarrhea.[2][5] Onset of symptoms is typically 10 to 60 minutes after eating and can last for up to two days.[2] Rarely, breathing problems, difficulty swallowing, redness of the mouth, or anirregular heartbeat may occur.[2][5]
Scombroid occurs from eating fish high inhistamine due to inappropriate storage or processing.[2] Fish commonly implicated includetuna,mackerel,mahi mahi,escolar,sardine,anchovy,bonito,herring,bluefish,amberjack, andmarlin.[2][6] These fish naturally have high levels ofhistidine, which is converted tohistamine whenbacterial growth occurs during improper storage.[2] Subsequent cooking, smoking, or freezing does not eliminate the histamine.[2] Diagnosis is typically based on the symptoms and may be supported by a normal bloodtryptase.[2][1] If a number of people who eat the same fish develop symptoms, the diagnosis is more likely.[2]
Prevention is by refrigerating or freezing fish right after it is caught.[2] Treatment is generally withantihistamines such asdiphenhydramine andranitidine.[2]Epinephrine may be used for severe symptoms.[3] Along withciguatera fish poisoning, it is one of the most common type ofseafood poisoning.[2] It occurs globally in bothtemperate andtropical waters.[2] Only one death has been reported.[3] The condition was first described in 1799.[1]
Symptoms typically occur within 10–30 minutes of ingesting the fish and generally are self-limited. People withasthma are more vulnerable torespiratory problems such aswheezing orbronchospasms. However, symptoms may show over two hours after eating a spoiled dish. They usually last for about 10 to 14 hours, and rarely exceed one to two days.
The first signs of poisoning suggest anallergic reaction with these symptoms:
The above symptoms can advance to:
In the worst cases, the poisoning may cause:
In rare cases, the poisoning may result in death.
Unlike many types of food poisoning, scombroid form is not brought about by ingestion of apathogen.[8]Histidine is anamino acid that exists naturally in many types of food, including fish. At temperatures above 16 °C (60 °F), histidine is converted to thebiogenic aminehistamine via the enzymehistidine decarboxylase produced bysymbioticbacteria such asMorganella morganii (this is one reason why fish should be stored in the freezer). Histamine is not destroyed by normal cooking temperatures, so even properly cooked fish can still result in poisoning.[9] Histamine is the main natural chemical responsible for true allergic reactions, so the symptoms produced are almost identical to afood allergy.[10][11] Rarely,cheese may be involved.[3]
Differentiating scombroid from a fish allergy can be difficult, as both present with similar symptoms.[1] In scombroid, bloodtryptase is generally normal, while in an allergic reaction, it is elevated.[1]
Cooking, smoking, canning, or freezing will not destroy histamine in contaminated fish.[2] Antihistamines may also be taken before eating seafood.[3]
Treatment is in the form of supportive care. If light-headedness occurs, a person should lie with feet partly elevated.Antihistamines such asdiphenhydramine (H1 blockade) andranitidine (H2 blockade) together withintravenous fluids may help with mild to moderate symptoms.[2][3]Epinephrine combined with asteroid may be used for severe symptoms.[3]
Isolated reports of scombroid food poisoning in humans caused by histamine present in the tissues of stale or rotten scombroid fish, usually tuna, have occurred over the years. In September 2016, authorities in Singapore intercepted canned tuna imported from Thailand after finding high levels of histamine.[12] No human cases were reported. The Shenzhen Post reported that histamine poisoning from scombroid fish happens often in the autumn inGuangdong province in China.[13] In August 2013, 26 people in Shenzhen were poisoned after eating stale mackerel. Several people became ill after eating tuna sandwiches at a cafe in Edinburgh in Scotland in 2013.[14] The tuna had come from Ghana. In 2011, 20 reports of food poisoning at a Stockholm restaurant were thought to be histamine poisoning in tuna from Senegal. In 2012, UK environmental health authorities in north east Lincolnshire intercepted and destroyed a shipment of tuna from Vietnam after four crew members were reported to have developed symptoms of histamine poisoning.[15] Commercially canned tuna was determined to be the cause of the poisoning of 232 persons in the north-central United States in 1973.[16]
The syndrome is named after the fish familyScombridae, which includesmackerels,tunas, andbonitos, because early descriptions of the illness noted an association with those species, although nonscombroid fish such asmahi-mahi andamberjack may also cause the condition.[citation needed]
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