scombroid food poisoning

Symptoms typically occur within 10–30 minutes of ingesting the fish and generally are self-limited. People with asthma are more vulnerable to respiratory problems such as wheezing or bronchospasms. 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 an allergic reaction with these symptoms:

• facial flushing/sweating
• burning-peppery taste sensations in the mouth and throat
• dizziness
• nausea
• headache
• tachycardia
• cold-like symptoms

The above symptoms can advance to:

• facial rash (intense itching may accompany the rash)
• torso or body rash: The rash associated with scombroid poisoning is a form of urticaria, but most commonly does not include wheals (patchy areas of skin-swelling also known as hives) that may be seen in true allergies.{{cite web|url=http://dermnetnz.org/reactions/scombroid.html|title=Scombroid fish poisoning|publisher=DermNet New Zealand Trust|date=15 December 2014}}
• edema (generalized if it occurs at all)
• short-term diarrhea
• abdominal cramps

In the worst cases, the poisoning may cause:

• blurred vision
• respiratory distress
• swelling of the tongue

In rare cases, the poisoning may result in death.

Unlike many types of food poisoning, scombroid form is not brought about by ingestion of a pathogen.{{cite journal |vauthors=Clark RF, Williams SR, Nordt SP, Manoguerra AS |title=A review of selected seafood poisonings |journal=Undersea Hyperb Med |volume=26 |issue=3 |pages=175–84 |year=1999 |pmid=10485519 |url=http://archive.rubicon-foundation.org/2314 |archive-url=https://web.archive.org/web/20081007062742/http://archive.rubicon-foundation.org/2314 |url-status=usurped |archive-date=October 7, 2008 |access-date=2008-08-12}} Histidine is an amino acid that exists naturally in many types of food, including fish. At temperatures above 16 °C (60 °F), histidine is converted to the biogenic amine histamine via the enzyme histidine decarboxylase produced by symbiotic bacteria such as Morganella 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.{{cite book|url=https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf |title=Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins |chapter=Scombrotoxin |publisher=U.S. Food and Drug Administration |first=Ronald A. |last=Benner}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}} Histamine is the main natural chemical responsible for true allergic reactions, so the symptoms produced are almost identical to a food allergy.{{cite web |url=https://www.fda.gov/Food/FoodborneIllnessContaminants/BuyStoreServeSafeFood/ucm335658.htm |archive-url=https://web.archive.org/web/20130511133800/http://www.fda.gov/Food/FoodborneIllnessContaminants/BuyStoreServeSafeFood/ucm335658.htm |url-status=dead |archive-date=May 11, 2013 |title=Scombrotoxin Poisoning and Decomposition |publisher=U.S. Food and Drug Administration |last=Otwell |first=W. Steven |date=2015-06-24 |access-date=2016-09-23}}{{cite book|author=Barry Leonard|title=Fish and Fishery Products: Hazards and Controls Guidance (4th Ed. )|url=https://www.fda.gov/downloads/Food/GuidanceRegulation/UCM252400.pdf|archive-url=https://web.archive.org/web/20140326124235/http://www.fda.gov/downloads/food/guidanceregulation/ucm252400.pdf|url-status=dead|archive-date=March 26, 2014|date=August 2011|publisher=DIANE Publishing|isbn=978-1-4379-8746-1|pages=113–}} Rarely, cheese may be involved.

Differentiating scombroid from a fish allergy can be difficult, as both present with similar symptoms. In scombroid, blood tryptase is generally normal, while in an allergic reaction, it is elevated.

Cooking, smoking, canning, or freezing will not destroy histamine in contaminated fish. Antihistamines may also be taken before eating seafood.

Treatment is in the form of supportive care. If light-headedness occurs, a person should lie with feet partly elevated. Antihistamines such as diphenhydramine (H1 blockade) and ranitidine (H2 blockade) together with intravenous fluids may help with mild to moderate symptoms. Epinephrine combined with a steroid may be used for severe symptoms.

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.{{cite web|title=Scombroid fish poisoning - Singapore: ex Thailand, canned tuna, recall, RFI 2016-09-21 21:37:42|url=http://www.promedmail.org/post/4503707|website=www.promedmail.org|publisher=International Society for Infectious Diseases|access-date=28 September 2016}} No human cases were reported. The Shenzhen Post reported that histamine poisoning from scombroid fish happens often in the autumn in Guangdong province in China.{{cite news|title=26 People Were Poisoned Because of Eating Stale Mackerel {{!}} Shenzhen Post|url=http://www.szpost.com/2013/08/26-people-were-poisoned-because-of-eating-stale-mackerel.html|access-date=28 September 2016|archive-date=2 October 2016|archive-url=https://web.archive.org/web/20161002034532/http://www.szpost.com/2013/08/26-people-were-poisoned-because-of-eating-stale-mackerel.html|url-status=dead}} 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.{{cite web|title=013-04-05 23:00:36 Scombroid fish poisoning - UK (Scotland) tuna sandwiches|url=http://www.promedmail.org/post/20130405.1623033|website=www.promedmail.org|access-date=28 September 2016}} 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.{{cite web|title=2011-10-22 16:44:38 Scombroid poisoning, tuna - Sweden: (Stockholm) restaurant|url=http://www.promedmail.org/post/20111022.3151|website=www.promedmail.org|publisher=International Society for Infectious Diseases}} Commercially canned tuna was determined to be the cause of the poisoning of 232 persons in the north-central United States in 1973.{{cite journal|last1=Merson|first1=MH|last2=Baine|first2=WB|last3=Gangarosa|first3=EJ|last4=Swanson|first4=RC|title=Scombroid fish poisoning. Outbreak traced to commercially canned tuna fish.|journal=JAMA|date=3 June 1974|volume=228|issue=10|pages=1268–9|pmid=4406515|doi=10.1001/jama.1974.03230350040026}}

The syndrome is named after the fish family Scombridae, which includes mackerels, tunas, and bonitos, because early descriptions of the illness noted an association with those species, although nonscombroid fish such as mahi-mahi and amberjack may also cause the condition.{{Cn|date=March 2024}}

{{Reflist}}

• [http://seafood.ucdavis.edu/haccp/compendium/Chapt27.htm Seafood Network Information Center] {{Webarchive|url=https://web.archive.org/web/20070206082424/http://seafood.ucdavis.edu/haccp/compendium/Chapt27.htm |date=2007-02-06 }}
• [http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/food-poisoning-from-marine-toxins.aspx Center for Disease Control: Food Poisonings from Marine Toxins]
• {{DermNet|reactions/scombroid}}

{{Medical resources

| DiseasesDB = 31114

| ICD10 = {{ICD10|T|61|1|t|51}}

| ICD9 = {{ICD9|988.0}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = emerg

| eMedicineTopic = 523

| MeshID =

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{{Poisoning and toxicity}}

{{seafood}}

{{Fish disease topics}}

{{Mackerel}}

Category:Toxic effect of noxious substances eaten as food

Category:Seafood

Category:Fish as food

Category:Fish diseases

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