Scombroid food poisoning

Scombroid food poisoning is a food borne illness that results from eating spoiled
(decayed) fish. It is the second most common type of seafood poisoning, second only to ciguatera.
However it is often missed because it resembles an allergic reaction. It is most commonly reported
with mackerel, tuna, mahi-mahi, bonito, sardines, anchovies, and related species of fish that were
inadequately refrigerated or preserved after being caught. Scombroid syndrome can result from
inappropriate handling of fish during storage or processing. One of the toxic agents implicated in
scombroid poisoning is histamine. Other chemicals have been found in decaying fish flesh, but their
association with scombroid fish poisoning has not been clearly established.

Causes:

Unlike many types of food poisoning, this form is not produced by an organism or virus.
Histidine exists naturally in many types of fish, and at temperatures above 16°C (60°F) on air
contact it is converted to the biogenic amine histamine via the enzyme histidine
decarboxylase produced by Morganella morganii (this is one reason why fish should be stored at
low temperatures). Histamine is not destroyed by normal cooking temperatures, so even properly
cooked fish can be affected. Histamine is a mediator of allergic reactions, so the symptoms
produced are those one would expect to see in severe allergic responses. The suspect toxin is an
elevated level of histamine generated by bacterial breakdown of histidine in the muscle protein
through elevated production of the enzyme histidine decarboxylase. This natural spoilage process is
thought to release additional by-products, which cause the toxic effect. Freezing, cooking, smoking,
curing and/or canning do not destroy the potential toxins.

Symptoms:

Symptoms consist of skin flushing, throbbing headache, oral burning, abdominal

cramps, nausea, diarrhea, palpitations, a sense of unease, and, rarely, collapse or loss of vision.
Symptoms usually occur within 10-30 minutes of ingesting the fish and generally are self-limited.
Physical signs may include a diffuse blanching erythema, tachycardia, wheezing,
andhypotension or hypertension. People with asthma are more vulnerable to respiratory problems
such as wheezing or bronchospasms. Symptoms of poisoning can show within just minutes, and up
to two hours, following consumption of a spoiled dish. Symptoms usually last for approximately
four to six hours and rarely exceed one to two days.
The first signs of poisoning suggest an allergic reaction with the following symptoms:

 Facial flushing/sweating
 Burning-peppery taste sensations in the mouth and throat
 Dizziness, Nausea, Headache, Tachycardia, Cold like symptoms

Additional symptoms: Facial rash, Hives (urticaria). Scombroid hives do not include weals
(patchy areas of skin-swelling) that may be seen in true allergies, Edema (this is generalized if it
occurs at all), Short-term diarrhea, Abdominal cramps.

In the worst cases, the poisoning may cause: Blurred vision, respiratory stress, swelling of the
tongue.

Recognition

Such reactions often go unrecognised or unreported because of a lack of understanding of

the condition, and confusion with the symptoms of other illnesses such as food allergy. The onset
of symptoms can be rapid, ranging from immediate to 30 minutes. The duration of the illness is
usually three hours, but may last several days. Patients may need tests of true food allergy (for
example to fish) to exclude this as an explanation for symptoms and to reassure the patient that the
blamed food need not be avoided in future.

All humans are susceptible to histamine poisoning; however it does appear that some
individuals may be more histamine-sensitive than others. Taking alcohol at the same meal can
increase the chance of a reaction and the symptoms are likely to be more severe for the elderly and
for those taking the following medications:

Augmentin (antibiotic)
Doxycyline (antibiotic)
Isoniazid (antibiotic used to treat tuberculosis)
Metoclopropramide (used to treat 'stomach upsets')
Verapamil (used to treat heart conditions)
Promethazine
Monoamine oxidase inhibitors (a type of antidepressant)
Certain herbal & Nutritional supplements

Diagnosis:
 Diagnosis of the illness is usually based on the patient's symptoms, time of onset, and the
response to treatment with antihistamine medication. If the condition is suspected at the time, it is
possible for the implicated food to be analysed within a few hours for elevated levels of histamine
to confirm a diagnosis.

Fishery products are particularly commonly implicated in scombroid poisoning; particularly

those from the Scombridae family including tuna, mahi mahi, bluefish, sardines, mackerel,
amberjack, and abalone. However other foods can occasionally cause a similar effect, for example
certain cheeses and soya bean curd (tofu). The toxin forms in a food when certain bacteria are
present and time and temperature permit their growth. Distribution of the toxin within an
individual fish fillet or between cans in a case lot can be uneven, with some sections of a product
causing symptoms and others not. Neither cooking, nor canning or freezing reduces the toxic
effect. Examination by the consumer cannot ensure the absence or presence of the toxin, although
it seems likely that odorous fish is more likely than non-odorous fish to cause a problem.