Etiology: histamine intoxication due to bacterial decomposition of inadequately preserved or refrigerated scombroid fish (e.g., tuna, mackerel, saury, needlefish, wahoo, skipjack, and bonito)
- This syndrome can also occur with nonscombroid fish (e.g., sardines, herring, dolphinfish, amberjack, and bluefish).
- Affected fish typically have a sharply metallic or peppery taste but may be normal in appearance and flavor.
- Because of uneven distribution of decay within the fish, not all people who eat an affected fish will become ill.
Clinical features: Within 15-90 min of ingestion, pts present with oral tingling, mild abdominal pain, and nausea. Pts with severe cases develop flushing (exacerbated by UV exposure), pruritus, urticaria, angioneurotic edema, bronchospasm, GI symptoms, and hypotension.
- Symptoms generally resolve within 8-12 h.
- May be worse in pts concurrently taking isoniazid because of inhibition of GI tract histaminases
Treatment: Scombroid Poisoning
Treatment consists of antihistamine (H1 or H2) administration.
If bronchospasm is severe, an inhaled bronchodilator or injected epinephrine may be used.