General characteristics

Scombroid poisoning is caused by the ingestion of foods that contain high levels of histamine and possibly other vasoactive amines and compounds. Histamine and other amines are formed by the growth of certain bacteria and the subsequent action of their decarboxylase enzymes on histidine and other amino acids in food, either during the production of a product such as Swiss cheese or by spoilage of foods such as fishery products, particularly tuna or mahi mahi. However, any food that contains the appropriate amino acids and is subjected to certain bacterial contamination and growth may lead to scombroid poisoning when ingested.

Disease symptoms

Initial symptoms may include a tingling or burning sensation in the mouth, a rash on the upper body and a drop in blood pressure. Frequently, headaches and itching of the skin are encountered. The symptoms may progress to nausea, vomiting, and diarrhoea and may require hospitalisation, particularly in the case of elderly or impaired patients.

The onset of intoxication symptoms is rapid, ranging from immediate to 30 minutes. The duration of the illness is usually 3 hours, but may last several days.

Diagnosis

Diagnosis of the illness is usually based on the patient's symptoms, time of onset, and the effect of treatment with antihistamine medication. The suspected food must be analyzed within a few hours for elevated levels of histamine to confirm a diagnosis.

Associated foods

Fishery products that have been implicated in scombroid poisoning include the tunas (e.g., skipjack and yellowfin), mahi mahi, bluefish, sardines, mackerel, amberjack, and abalone. Many other products also have caused the toxic effects. The primary cheese involved in intoxications has been Swiss cheese.

The toxin forms in a food when certain bacteria are present and time and temperature permit their growth.

Distribution of the toxin within an individual fish fillet or between cans in a case lot can be uneven, with some sections of a product causing illnesses and others not.

Prevention

Neither cooking, canning, or freezing reduces the toxic effect. Common sensory examination by the consumer cannot ensure the absence or presence of the toxin. Chemical testing is the only reliable test for evaluation of a product. Therefore all non-fresh or improperly preserved fish products may contain histamine or related products. Fortunately, production of histamine often, but not always, correlates with the production of ammonia, resulting in a clear spoiled or off-smell.

Risk populations

All humans are susceptible to scombroid poisoning; however, the symptoms can be severe for the elderly and for those taking medications such as isoniazid. Because of the worldwide network for harvesting, processing, and distributing fishery products, the impact of the problem is not limited to specific geographical areas or consumption pattern.