Dr. Muhlfelder presents today’s Morning Report!
SCOMBROID
The “seafood allergy”/ Histamine Toxicity
- Significantly underreported-misdiagnosed as seafood allergy
- Contaminated dark meat fish i.e. tuna, mackerel, skip-jack and bonito (name derived from Scromdroidea class of fish initially associated with illness)
- Less likely, but reported: mahi mahi, swordfish, sardines, salmon AND contaminated SWISS CHEESE!
- In US, mostly recreational fish catches with improper storage/freezing to <38 F
- With bacterial overgrowth histidine is converted to histamine, completed by a decarboxylase found within E.coli, Vibrio, Proteus, Klebsiella, Morganella morganii, Salmonella and Shigella
- Not eradicated with cooking, freezing
- Described as peppery, spicy, bubbly
Presentation:
- Rapid onset of flushing, urticarial rash w/ prominence on trunk and face, headache, diarrhea
- Perioral burning/itch, uncomfortable sensation of warmth, dizziness, palpitations, tachycardia
- Increased concern in pts with underlying pulmonary disease, or on isoniazid (inhibits histamine metabolism)
- Rarely pt presents with upper airway edema, hypotension or bronchospasm- which should warrant anaphylaxis therapy
- Can present as multiple pt’s with same symptoms
- Improves rapidly w anti-histamine therapy
- Treatment: supportive care, H1 (Benadryl or hydroxyzine) or H2 (ranitidine or cimetidine) antagonists, loratadine, cetirizine
- Recurrence reaction from continued toxin absorption from GI tract
Similar presentations:
- #1 food allergy in US, IgE mediated- shellfish
- Ciguatera poisoning from toxin ingested by carnivorous reef fish (barracuda, moray eel, grouper..)
- GI complaints + Neuro symptoms: paresthesias, transient blindness/blurred vision, cold allodynia
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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