Scombroid fish poisoning

Scombroid fish poisoning symptoms are flushing of the face, headache, nausea and vomiting, dizziness, and paresthesias. It is caused by high concentrations of histamine (>500 ppm) formed in decomposing fish, e.g., tuna, mackerel, and other Scombroidea fish. Symptoms resolve in 6 to 36 hours.

CASES/YEAR
7,500 (US); 150,000 (Global)
CATEGORY
Foodborne Intoxications
AGENT TYPE
Toxins
OTHER NAMES
Histamine poisoning; Pseudoallergic fish poisoning;
ACUITY
Acute-Moderate
INCUBATION
Within a few hours of eating fish; [CCDM]
INITIAL SYMPTOMS
Flushing of face, headache, nausea and vomiting, dizziness, paresthesias;
PRECAUTIONS
COMMENTS
Scombroid fish poisoning is caused by high concentrations of histamine (>500 ppm) formed in decomposing fish, e.g., tuna, mackerel, and other fish in the Scombroidea fish group. Symptoms begin within a few hours of eating and include facial flushing, nausea/vomiting, headache, rash, dizziness, and burning sensations around the mouth. Symptoms resolve within 12 hours. [CCDM, p. 223] The histamines causing this pseudoallergic reaction are derived from fish proteins, inadequately refrigerated and decomposing. [Cecil, p. 694] Other implicated fish are albacore, bluefin, saury, needle-fish, wahoo, kahawai, sardine, black marlin, pilchard, anchovy, herring, amberjack, and Australian ocean salmon. Other symptoms are flushing, angioneurotic edema, bronchospasm, abdominal cramping, pharyngitis, tachycardia, and hypotension. [Harrison ID, p. 1173-4] Urticaria and bronchospasm may occur in severe cases. [PPID, p. 1386]
DIAGNOSTIC
Clinical; Histamine in fish;
SCOPE
Global
SIGNS & SYMPTOMS
  • E dysphagia
  • E pharyngitis
  • G abdominal pain
  • G diarrhea
  • G nausea, vomiting
  • N headache
  • N paresthesia
  • R dyspnea
  • S rash (exanthem)
  • S urticaria
ANTIMICROBIC

No

VACCINE

No

ENTRY
Ingestion
SOURCE
Animal Tissue, Eating Infected or Toxin-Containing Fish
RESERVOIR
Fish and Shellfish
RISK FACTORS
  • Ingest toxins in food or water
TREATMENT
Symptoms resolve in 6 to 36 hours. Fatal cases reported; Treatment includes antihistamines, albuterol, corticosteroids, and IM epinephrine. [Cecil, p. 694]
DRUG LINK
CDC - Marine Toxins
REFERENCES FOR CASES/YEAR
1. (US) 1/20 X global cases/yr;
2. (Global) Most common seafood poisoning worldwide; 400 suspected cases reported in UK between 1976 and 1990; [Whittle2000: PMID 10885118] Guesstimate: Assume population of 60 million for UK with 400/14 = about 30 cases per year or 0.5 case/million; Assume underreporting by a factor of 50 = 25 cases/million; 25 X 300 = 7500 cases (US) and 25 X 6000 = 150,000 cases/year (global);