II. Epidemiology
- More common in Hawaii and California
III. Pathophysiology
- Improper handling of fish (delay to refrigeration, poorly refrigerated or inadequately frozen)
- Scombridae family or dark meat fish such as Tuna, Mahi-mahi,or mackerel
- Food typically tastes atypical
-
Histidine from fish Muscle is decarboxylated to Histamine by marine Bacteria
- Bacteria containing Histidine decarboxylase include Escherichia, Klebsiella, Proteus, Vibrio, Pseudomonas
- Isoniazid potentiates this reaction
IV. Causes: Scombridae Family Fish
- Mackerel
- Marlin
- Bonito Fish
- Yellowfin Tuna
- Albacore Tuna
- Skipjack Tuna
V. Symptoms (Related to Histamine release)
- Typical Histamine related response
- Severe Flushing including facial Flushing
- Diarrhea
- Palpitations
- Abdominal Pain
- Urticaria
- Bronchospasm with Wheezing
- Orthostatic Hypotension
- Bitter, pepper or Metallic Taste (Dysgeusia)
- Histamine-3 (H3) activity related symptoms
VI. Labs
- Avoid Histamine level (not useful)
- Tryptase level
- May differentiate from Allergic Reactions
VII. Differential Diagnosis
VIII. Course
- Onset within 10-60 min (on average 20-30 min) of ingestion
- Resolves within 6-8 hours, up to 24 hours (rarely more)
IX. Management
- Avoid Gastric Decontamination in most cases
-
Antihistamine
- Diphenhydramine (Benadryl) 50 mg IV/IM}PO
- Consider H2 Receptor Blocker (Ranitidine, Cimetidine)
-
Nebulized Albuterol
- Indicated for bronchospasm
- Other symptomatic management
X. References
- Koch and Tomaszewski (2018) Crit Dec Emerg Med 32(1): 24
- Stratta (2012) Scombroid Poisoning 184(6):674 +PMID:22231690 [PubMed]