(scombrotoxism)

Pseudoallergic reaction due to the ingestion of large amounts of histamine during a meal with improperly preserved fish. It could be responsible for about 40% of 'poisonings' subsequent to ingestion of fish.

The cases are most often due to ingestion of fish of the scombridae family (mackerel, sardine, tuna, dolphin) that has not been preserved at a cold enough temperature immediately after fishing. Cases have also been described with fish from other families.

This flesh is very rich in histidine, and the digestive tract of those fishes contains  gram-  bacteria (E Coli, Klebselliae, Proteus, Salmonella ...) that produce a histidine decarboxylase transforming histidine into histamine. Histamine is heat stable (and therefore resists cooking) but is normally destroyed in the digestive tract. Signs due to the absorption of histamine are probably due to

-        the co-ingestion of other toxins such as putrescine, cadaverine and urocanic acid

-        an individual genetic susceptibility.

Clinical signs:

-        within 15 to 90 min following fish ingestion, signs of anaphylactoid reaction of variable gravity: itchy rash, abdominal pain, diarrhea, vomiting, bronchospasm, hypotension, tachycardia, sometimes coronary spasm

Treatment: antiH1 (0.5 to 1.5 mg/kg diphenhydramine), fluid resuscitation, bronchodilator, if necessary corticoids or vasopressors

Anesthetic implications:

diagnosis to be kept in mind in case of abdominal pain with shock after fish ingestion

References :

-        Iannuzzi M, D’Ignazio N, Bressy L, De Sio A.
Severe scombroid poisoning syndrome requiring aggressive fluid resuscitation in the emergency department : two case reports.
Minerva Anesthesiologica 2007; 73: 481-3

-        Tortorella V, Masciari P, Pezzi M, Mola A et al.
Histamine poisoning from ingestion of fish or scombroid syndrome.
Case Reports in Emergency Medicine 2014, ID 482531, 4p

-        Marissiaux L, Scippo M-L, Daube G, Denayer S, Botteldoorn N, Gobert S, Scholtes B, Ghuysen A.
An awkward fishing expedition.
Acta Anaesth Belg 2018; 69: 119-22.

Updated: July 2018