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Revision as of 13:13, 22 March 2016

Background

  • Common in Hawaii, then FL
  • Frequently misdiagnosed as seafood allergy
  • Most of the cases associated with tuna, bluefish, and mahi-mahi
    • Also herring, mackerel, skip-jack, sardine, and bonito
  • Bacteria in fish produce produce heat-stable toxins causing histamine release when consumed[1]

Clinical Presentation

  • Fish dish taste metallic, bitter, or peppery[2]
  • Starts within one hour of ingestion
    • Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea within 30 min of consumption
    • Severe throbbing headache, blurred vision, dizziness
    • Significant tachycardia, palpitations, and possible respiratory distress
  • Usually resolves within 12 hours if untreated and has no long-term sequelae

Differential Diagnosis

  • Ciguatera - similar clinical presentation, different fish

Acute allergic reaction

Diagnosis

Usually clinical

Treatment

  • H1 and H2 agonists
  • Epi and albuterol if bronchospasm

See Also

Source

  1. Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222
  2. Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222