You are on a blind date at a new Hawaiian restaurant. You order the Ahi tuna poke bowl. Thirty minutes into eating you suddenly feel stomach cramps, and your head begins throbbing. Your date asks if you are okay and are allergic to fish because your face is beet red. You feel the sudden urge to defecate, and as you get up to run to the bathroom you note the name of the restaurant, “Scombroid Sam’s”.
What is scombroid?
Scombroid is the common term for histamine fish poisoning. It gets its name from the family of fish Scombridae (tuna, mackerel, other species) which typically cause the poisoning. However, a large variety of fish can cause scombroid, most of them dark meat fish. These fish have high levels of histidine in the meat. If that meat is improperly refrigerated, bacteria on the surface of the meat convert histidine to histamine, which is the principal cause of the symptoms.
What are symptoms of scombroid?
Symptoms of scombroid are from histamine intoxication. They typically come on rapidly, 20 – 30 minutes after eating the fish. They include flushing, diarrhea, abdominal cramps, headache, and palpitations. Facial flushing is a telling characteristic and often looks like a sunburn. These symptoms typically last less than 6 hours.
How do you treat scombroid?
Treatment is with anti-histamines. If in the Emergency Department setting, IV diphenhydramine or cimetidine can relieve symptoms rapidly.
Other fun facts:
- Scombroid is not an allergic reaction, so patients should not think they are allergic to fish.
- Improper refrigeration is typically from the supplier rather than the restaurant.
- Cases should be reported to the health department
- For more information on the numerous ways eating fish can harm your health see this fantastic post on ciguatera poisoning from Kyle Birnbaum PGY4 – Bored Review and Something’s Fishy
References: Nguyen, Thomas and Saadia Akhtar. Gastroenteritis. In: Walls R, Hockberger R, Gausche-Hill M. Rosen’s Emergency Medicine: Concepts and Clinical Practice, Ninth Edition Philadelphia, PA: Elsivier Inc; 2018.
Images obtained from Rosh Review 2017.
Disclaimer: This post is for Board Review. The answers on boards or in-service are not necessarily based on up to date evidence.
Charles Murchison
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