Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

Abstract

We report a case of scombrotoxin poisoning, an acute illness that develops within minutes to hours of eating poorly processed oily fish, such as tuna or mackerel. It presents with symptoms that can mimic an anaphylactic reaction. It is presumed to arise due to ingestion of histamine that is formed by contaminating bacteria that have flourished during periods of suboptimal refrigeration, following capture. Knowledge of this underdiagnosed malady as a potential differential diagnosis for patients presenting with symptoms suggestive of histamine release is important. It is a notifiable condition. The alternative diagnosis of anaphylaxis may have significant lifestyle implications for the patient. This article reports on one such presentation and the way that the diagnosis was explored.
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References

  1. Lavon. O, Lurie Y, Bentur Y. Scombroid fish poisoning in Israel 2005- IMAJ 2008; (10): 789–792.
  2. Mines D., Stahmer S., Shepherd SM. Poisonings: food, fish, shellfish. Emerg. Med Clin North Am 1997; (15): 157.
  3. Poisindex. Scombroid fish poisoning. Accessed from http://www. thomsonhc.com on 11/6/09.
  4. Working Group of the Resuscitation Council. Investigations. In: Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers. Resuscitation Council UK 2008. pp 27–28.
  5. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am 2006; 26(3): 451–63.
  6. Caughey GH. Tryptase genetics and anaphylaxis. J Allergy Clin Immunol 2006; 117(6): 1411–1414.
  7. Sampson HA, Mendelson L, Rosen JP. Fatal and near fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992: 327–380.
  8. Yunginger JW, Nelson DR, Squillace DL et al. Laboratory investigations of deaths due to anaphylaxis. J Forensic Sci 1991; 36: 857.
  9. Centers for Disease Control and Prevention. Scombroid fish poisoning associated with tuna steaks – Louisiana and Tennessee, 2006. JAMA 2007;
    298(11): 1269–1270.
  10. Feldman KA, Werner SB, Cronan S et al. A large outbreak of scombroid fish poisoning associated with eating escolar fish (Lepidocybium flavobrunneum) Epidemiol Infect 2005; 133: 29–33.

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Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

9th March 2016
PMID: 21597578
Authors Affiliations
Numbere K Numbere Core Medical Training ST2, Department of Haematology, Queen Alexandra Hospital Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth. PO6 3LY Email: numbere@doctors .org.uk
Peter Featherstone Consultant in Acute Medicine, Medical Assessment Unit, Queen Alexandra Hospital
Hywel L Cooper Specialist Registrar, Department of Dermatology, St. Mary’s Hospital,

Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

Cite this article as:

Numbere NK, Featherstone P, Cooper HL. Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis. Acute Med. 2010;9(2):80-1. PMID: 21597578.

Scombrotoxin poisoning: an important differential diagnosis for anaphylaxis

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