Scombroidosis

 Q: A group of physicians attending a medical conference has been admitted to ICU - a couple of them intubated - after having a seafood dinner together and developing severe anaphylaxis type reactions. History and cluster presentation led to the diagnosis of Scombroidosis. The major cause of the scombroid syndrome is uncooked fish? 

A) True 

B) False 

Answer: B 

The other name for scombroidosis or scombroid syndrome is histamine fish poisoning. This usually occurs within an hour or so after ingesting the spoiled finned fish. This includes tuna, mahi mahi, sardines, anchovies, herring, and others. 

This is secondary to high histamine content in the spoiled fish. Interestingly, even proper cooking does not reduce the histamine level in an already spoiled fish. The growth of bacteria in an spoiled fish meat decarboxylate the amino acid L-histidine to histamine. 

Although symptoms are similar to anaphylaxis, it is not a true anaphylaxis reaction. It can be distinguished from true allergy by measuring serum-specific IgE to the implicated fish. The other way is to obtaining a sample of spoiled fish and perform a dermal test in patients and controlled.

#toxicology

#allergy

References:

1. Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J 2020; 13:100472. 

2. Hungerford JM. Scombroid poisoning: a review. Toxicon 2010; 56:231.

3. Kelso JM, Lin FL. Skin testing for scombroid poisoning. Ann Allergy Asthma Immunol 2009; 103:447.