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Scombroid poisoning

Authors:
Paolo Stratta at Mental Heatlh Center
Paolo Stratta
  • Mental Heatlh Center
Guido Badino at University of Turin
Guido Badino
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Abstract

Scombroid poisoning is described in the literature as a toxic poisoning caused by ingestion of certain dark meat fish undergoing bacterial decomposition. Poisoning results from the ingestion of a heat-stable toxin. We describe the case of a man who presented to the emergency department several hours after eating tuna steak with evidence of scombroid poisoning that was associated with loss of vision and atrial tachycardia with block. All signs and symptoms resolved after treatment for scombroid poisoning. [McInerney J, Sahgal P, Vogel M, Rahn E, Jonas E: Scombroid poisoning. Ann Emerg Med August 1996;28:235-238.]
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References
1. Jantschitsch C, Kinaciyan T, Mana M, et al. Severe
scombroid sh poisoning: an underrecognized der-
matologic emergency. J Am Acad Dermatol 2011;
65:246-7.
2. Hungerford JM. Scombroid poisoning: a review.
Toxicon 2010;56:231-43.
3. O’Connor MM, Forbes GM. Scombroid poisoning:
not sh allergy. Aust N Z J Med 2000;30:520.
4. Morrow JD, Margolies GR, Rowland J, et al. Evi-
dence that histamine is the causative toxin of scom-
broid-sh poisoning. N Engl J Med 1991;324:716-20.
5. Attaran RR, Probst F. Histamine sh poisoning: a
common but frequently misdiagnosed condition.
Emerg Med J 2002;19:474-5.
2
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Five things to know about …
Scombroid poisoning
Piero Stratta MD, Guido Badino PhD
1
Scombroid poisoning is a common
form of food poisoning related to
sh ingestion
Scombroid poisoning occurs after the
ingestion of fresh, canned or smoked sh
with high histamine levels due to im -
proper processing or storage. First de -
scribed in conjunction with sh in the
suborder Scombroidea (e.g., tuna and
mackerel), it has since been described
with other dark-eshed sh (e.g., sar-
dines and ancho vies). Scombroid poison-
ing is one of the most common causes of
morbidity associated with sh intake.1,2
Scombroid poisoning is not an allergy
Allergic reactions typically affect one person who has a history of allergy to the
implicated food item. However, with scombroid poisoning, more than one per-
son, often with no history of allergies, may be affected.3Histamine produced by
the decarboxylation of histidine in the muscle of the sh is primarily responsible
for the condition. The decarboxylation process is induced by enzymes produced
by primarily enteric gram-negative bacteria (e.g., Morganella morganii,
Escherichia coli, Klebsiella species and Pseudomonas aeruginosa) found in the
sh’s cutis and intestines.1,2
Competing interests: None declared.
This article has been peer reviewed.
Afliations: From the Department of Nephrol-
ogy and Transplantation (Stratta), Amedeo Avo-
gadro University, Novara, Italy; and the Depart-
ment of Animal and Human Biology (Badino),
University of Torino, Torino, Italy
Correspondence to: Dr. Piero Stratta, piero.stratta
@med.unipmn.it
CMAJ 2012. DOI:10.1503/cmaj.111031
3
Symptoms are that of histamine
poisoning
Symptoms of scombroid poisoning
include ushing, rash, urticaria (gen-
erally widespread erythema, usually
lacking wheals), palpitations, head -
ache, dizziness, sweating, and burn-
ing of the mouth and throat. Gas-
trointestinal symptoms can in clude
abdominal cramps, nausea, vomiting
and diarrhea. Broncho spasm, respira-
tory distress and vasodilatory shock
have also been described. Symptoms
begin within 10 to 90 minutes after
eating the implicated sh. The rash
lasts 2–5 hours, and the other symp-
toms usually disappear within 3–36
hours. The diagnosis is often clinical
and can be conrmed by measure-
ment of histamine in incriminated
spoiled food. Determination of the
patient’s histamine level in plasma or
the level of histamine metabolites
(e.g., N-methylhistamine) in urine can
also support the diagnosis.4
Histamine does not change the smell
or appearance of the affected sh
Scombroid poisoning is frequently
misdiagnosed.5Because histamine
does not alter the organoleptic quality,
the sh may seem normal. However,
elevated histamine levels can occur in
sh owing to improper refrigeration
before processing or to storage of the
sh at room temperature after cook-
ing. Therefore, the appearance, taste
and smell of the sh are poor guides
as to the presence of histamine. Hista-
mine is heat-stable and remains pres -
ent after cooking, freezing, canning or
smoking. Outbreaks are most common
in summer.1,2
Treatment involves antihistamines
and supportive care
Most instances of scombroid poison-
ing are self-limited. However, if the
patient has symptoms severe enough
to re quire treatment, rapid-acting
antihistamines (usually H1-receptor
antagonists) are commonly used,
along with supportive care tailored to
the symptoms. Adrenalin and corti -
co steroids are generally not indi-
cated.1,2,5 To prevent further instances
of poisoning, public health authori-
ties should be notied to investigate
the source and remove the impli-
cated product from distribution.
... Although SFP is mainly related to seafood poisoning, it was also reported after consumption of contaminated cheese [40]. Symptoms can last from a few hours up to a maximum of 36 h and a correct clinical diagnosis requires measuring the histamine level in the blood plasma, and the level of histamine metabolites in the urine of the patient [41]. Treatment, if necessary, involves fast-acting antihistamines and supportive care. ...
... It is worthwhile to mention that fish with high concentrations of histamine may still retain a normal, unsuspicious appearance and odor [44], but it is unsafe for consumption. Furthermore, histamine is heat-stable and will not be inactivated by elevated temperatures such as during cooking and smoking [41]. ...
... While intake of histamine-contaminated seafood is the main reason for SPF [41], it is also known that oral intake of pure histamine by healthy volunteers causes only mild SFP symptoms [45]. The major enzymes responsible for the metabolic degradation of histamine are diamine oxidase DAO and histamine-N-methyltransferase HNMT [46]. ...
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Scombroid Poisoning: A Review
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Scombroid poisoning, also called histamine fish poisoning, is an allergy-like form of food poisoning that continues to be a major problem in seafood safety. The exact role of histamine in scombroid poisoning is not straightforward. Deviations from the expected dose-response have led to the advancement of various possible mechanisms of toxicity, none of them proven. Histamine action levels are used in regulation until more is known about the mechanism of scombroid poisoning. Scombroid poisoning and histamine are correlated but complicated. Victims of scombroid poisoning respond well to antihistamines, and chemical analyses of fish implicated in scombroid poisoning generally reveal elevated levels of histamine. Scombroid poisoning is unique among the seafood toxins since it results from product mishandling rather than contamination from other trophic levels. Inadequate cooling following harvest promotes bacterial histamine production, and can result in outbreaks of scombroid poisoning. Fish with high levels of free histidine, the enzyme substrate converted to histamine by bacterial histidine decarboxylase, are those most often implicated in scombroid poisoning. Laboratory methods and screening methods for detecting histamine are available in abundance, but need to be compared and validated to harmonize testing. Successful field testing, including dockside or on-board testing needed to augment HACCP efforts will have to integrate rapid and simplified detection methods with simplified and rapid sampling and extraction. Otherwise, time-consuming sample preparation reduces the impact of gains in detection speed on the overall analysis time.
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Evidence That Histamine Is the Causative Toxin of Scombroid-Fish Poisoning
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The highest morbidity worldwide from fish poisoning results from the ingestion of spoiled scombroid fish, such as tuna and mackerel, and its cause is not clear. Histamine could be responsible, because spoiled scombroid fish contain large quantities of histamine. Whether histamine is the causative toxin, however, has remained in question. To address this issue, we investigated whether histamine homeostasis is altered in poisoned people. The urinary excretion of histamine and its metabolite, N-methylhistamine, was measured in three persons who had scombroid-fish poisoning (scombrotoxism) after the ingestion of marlin. We measured 9 alpha, 11 beta-dihydroxy-15-oxo-2,3,18,19-tetranorprost-5-ene-1,20-dioic acid (PGD-M), the principal metabolite of prostaglandin D2, a mast-cell secretory product, to assess whether mast cells had been activated to release histamine. The fish contained high levels of histamine (842 to 2503 mumol per 100 g of tissue). Symptoms of scombrotoxism--flushing and headache--began 10 to 30 minutes after the ingestion of fish. In urine samples collected one to four hours after fish ingestion, the levels of histamine and N-methylhistamine were 9 to 20 times and 15 to 20 times the normal mean, respectively. During the subsequent 24 hours, the levels fell to 4 to 15 times and 4 to 11 times the normal values. Levels of both were normal 14 days later. PGD-M excretion was not increased at any time. Two persons treated with diphenhydramine had prompt amelioration of symptoms. Scombroid-fish poisoning is associated with urinary excretion of histamine in quantities far exceeding those required to produce toxicity. The histamine is most likely derived from the spoiled fish. These results identify histamine as the toxin responsible for scombroid-fish poisoning.
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Histamine fish poisoning: A common but frequently misdiagnosed condition
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