Scombroid food poisoning

{{short description|Foodborne illness that typically results from eating spoiled fish}} {{Infobox medical condition (new) | name = Scombroid food poisoning | image = File:Histamine_3D_ball.png | caption = Histamine | pronounce = | field = Emergency medicine | synonyms = Scombrotoxin fish poisoning, scombroid syndrome,<ref name=Rid2016/> scombroid,<ref name=Yellow2018/> histamine fish poisoning,<ref name=Rid2016/> scombroid poisoning<ref name=Fen2015/> | symptoms = Flushed skin, headache, itchiness, blurred vision, abdominal cramps, diarrhea<ref name=Yellow2018/> | complications = | onset = After 10 to 60 min<ref name=Yellow2018/> | duration = Up to 2 days<ref name=Yellow2018/> | types = | causes = Consumption of fish high in histamine due to improper processing<ref name=Yellow2018/> | risks = Tuna, mackerel, mahi mahi, sardine, anchovy, herring, bluefish, amberjack, marlin.<ref name=Yellow2018/> | diagnosis = Typically based on symptoms, blood tryptase<ref name=Yellow2018/><ref name=Rid2016/> | differential = Allergic reaction,<ref name=Yellow2018/> fish allergy<ref name=Rid2016/> | prevention = | treatment = Antihistamines, epinephrine<ref name=Yellow2018/><ref name=Fen2015/> | medication = | prognosis = | frequency = Relatively common<ref name=Yellow2018/> | deaths = Very rare<ref name=Fen2015/> }} <!-- Definition and symptoms -->

'''Scombroid food poisoning''', also known as simply '''scombroid''', is a foodborne illness that typically results from eating spoiled fish.<ref name=Yellow2018/><ref>{{Cite journal |last=Nutrition |first=Center for Food Safety and Applied |date=2022-01-21 |title=Scombrotoxin Poisoning and Decomposition |url=https://www.fda.gov/food/seafood-guidance-documents-regulatory-information/scombrotoxin-poisoning-and-decomposition |archive-url=https://web.archive.org/web/20190926143225/https://www.fda.gov/food/seafood-guidance-documents-regulatory-information/scombrotoxin-poisoning-and-decomposition |url-status=dead |archive-date=September 26, 2019 |journal=FDA |language=en}}</ref> Symptoms may include flushed skin, sweating, headache, itchiness, blurred vision, abdominal cramps and diarrhea.<ref name=Yellow2018/><ref name=":0">{{Cite web |title=Scombroid Fish Poisoning |url=https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/ScombroidFish%20Poisoning.aspx |access-date=2023-07-25 |website=www.cdph.ca.gov}}</ref> Onset of symptoms is typically 10 to 60 minutes after eating and can last for up to two days.<ref name=Yellow2018/> Rarely, breathing problems, difficulty swallowing, redness of the mouth, or an irregular heartbeat may occur.<ref name=Yellow2018/><ref name=":0" />

<!-- Cause and diagnosis --> Scombroid occurs from eating fish high in histamine due to inappropriate storage or processing.<ref name=Yellow2018/> Fish commonly implicated include tuna, mackerel, mahi mahi, escolar, sardine, anchovy, bonito, herring, bluefish, amberjack, and marlin.<ref name=Yellow2018/><ref>{{Cite web |last=Nikov |first=Dim |date=2023-07-24 |title=Why Does Tuna Hurt My Stomach? |url=https://homecookworld.com/why-does-tuna-hurt-my-stomach/ |access-date=2023-07-25 |website=Home Cook World |language=en-US}}</ref> These fish naturally have high levels of histidine, which is converted to histamine when bacterial growth occurs during improper storage.<ref name=Yellow2018/> Subsequent cooking, smoking, or freezing does not eliminate the histamine.<ref name=Yellow2018/> Diagnosis is typically based on the symptoms and may be supported by a normal blood tryptase.<ref name=Yellow2018/><ref name=Rid2016>{{cite journal |last1=Ridolo |first1=E |last2=Martignago |first2=I |last3=Senna |first3=G |last4=Ricci |first4=G |title=Scombroid syndrome: it seems to be fish allergy but... it isn't. |journal=Current Opinion in Allergy and Clinical Immunology |date=October 2016 |volume=16 |issue=5 |pages=516–21 |doi=10.1097/ACI.0000000000000297 |pmid=27466827|s2cid=21610715 }}</ref> If a number of people who eat the same fish develop symptoms, the diagnosis is more likely.<ref name=Yellow2018/>

<!-- Prevention, treatment, epidemiology --> Prevention is by refrigerating or freezing fish right after it is caught.<ref name=Yellow2018/> Treatment is generally with antihistamines such as diphenhydramine and ranitidine.<ref name=Yellow2018/> Epinephrine may be used for severe symptoms.<ref name=Fen2015>{{cite journal |last1=Feng |first1=C |last2=Teuber |first2=S |last3=Gershwin |first3=ME |title=Histamine (Scombroid) Fish Poisoning: a Comprehensive Review. |journal=Clinical Reviews in Allergy & Immunology |date=February 2016 |volume=50 |issue=1 |pages=64–9 |doi=10.1007/s12016-015-8467-x |pmid=25876709|s2cid=34835091 }}</ref> Along with ciguatera fish poisoning, it is one of the most common type of seafood poisoning.<ref name=Yellow2018>{{cite web |title=Food Poisoning from Marine Toxins - Chapter 2 - 2018 Yellow Book |url=https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/food-poisoning-from-marine-toxins |website=CDC |access-date=1 June 2018 |language=en-us |date=2017}}{{PD-notice}}</ref> It occurs globally in both temperate and tropical waters.<ref name=Yellow2018/> Only one death has been reported.<ref name=Fen2015/> The condition was first described in 1799.<ref name=Rid2016/>

== Signs and symptoms == 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.

=== Initial === 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

=== Additional 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.<ref>{{cite web|url=http://dermnetnz.org/reactions/scombroid.html|title=Scombroid fish poisoning|publisher=DermNet New Zealand Trust|date=15 December 2014}}</ref> * edema (generalized if it occurs at all) * short-term diarrhea * abdominal cramps

=== Severe === 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.

==Causes== Unlike many types of food poisoning, scombroid form is not brought about by ingestion of a pathogen.<ref name=uhm>{{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}}</ref> Histidine is an amino acid that exists naturally in many types of food, including fish. At temperatures above 16&nbsp;°C (60&nbsp;°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.<ref name="BadBug">{{cite book |last=Benner |first=Ronald A. |url=https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf |title=Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins |publisher=U.S. Food and Drug Administration |pages=207–210 |chapter=Scombrotoxin}}</ref> Histamine is the main natural chemical responsible for true allergic reactions, so the symptoms produced are almost identical to a food allergy.<ref name=fda1>{{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}}</ref><ref name="Leonard2011">{{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–}}</ref> Rarely, cheese may be involved.<ref name=Fen2015/>

==Diagnosis== Differentiating scombroid from a fish allergy can be difficult, as both present with similar symptoms.<ref name=Rid2016/> In scombroid, blood tryptase is generally normal, while in an allergic reaction, it is elevated.<ref name=Rid2016/>

==Prevention== Cooking, smoking, canning, or freezing will not destroy histamine in contaminated fish.<ref name="Yellow2018" /> Antihistamines may also be taken before eating seafood.<ref name=Fen2015/>

== Treatment == 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.<ref name=Yellow2018/><ref name=Fen2015/> Epinephrine combined with a steroid may be used for severe symptoms.<ref name=Fen2015/>

==Epidemiology== 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.<ref>{{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}}</ref> 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.<ref>{{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}}</ref> 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.<ref>{{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}}</ref> 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.<ref>{{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}}</ref> Commercially canned tuna was determined to be the cause of the poisoning of 232 persons in the north-central United States in 1973.<ref>{{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}}</ref>

==History== 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}}

== References == {{Reflist}}

== External links == * [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 = }} {{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 Category:Wikipedia medicine articles ready to translate