Scombroid

Background

• Caused by eating fish which have been improperly stored/refrigerated
  • Bacteria grow and produce heat-stable toxin that causes histamine release when consumed
  • Patient may complain that the fish tasted like pepper, metallic, or bitter
• Commonly associated fish include: tuna, bluefish, mahi-mahi, herring, mackerel, skip-jack, sardine, and bonito
• Frequently misdiagnosed as seafood allergy

Clinical Features

• Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
• Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea
• May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress

Differential Diagnosis

• Ciguatera - similar clinical presentation, different fish

Acute allergic reaction

• Allergic reaction/urticaria
• Anaphylaxis
• Angioedema
• Anxiety attack
• Asthma exacerbation
• Carcinoid syndrome
• Cold urticaria
• Contrast induced allergic reaction
• Scombroid
• Shock
• Transfusion reaction

Evaluation

• Generally clinical diagnosis

Management

• Antihistamines - give both H1 and H2 antagonists
• Consider epinephrine, albuterol if symptoms of respiratory distress

Disposition

• Generally may be discharged

See Also

• Marine toxins and envenomations