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• Scombroid - We need another solution
  Alon Duby
  Published on: 29 April 2016

• Published on: 29 April 2016

  Scombroid - We need another solution

  • Alon Duby

  Dear Editor

  I was interested to read the case report on histamine fish poisoning by Attaran et al.[1] Having recently reviewed the subject, I am aware that this journal has highlighted this common condition in 1997 with another case report,[2] adding to an expanding library of over 150 citations in popular databases in the past quarter century.

  Despite underreporting, the condition still accounte...

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  Dear Editor

  I was interested to read the case report on histamine fish poisoning by Attaran et al.[1] Having recently reviewed the subject, I am aware that this journal has highlighted this common condition in 1997 with another case report,[2] adding to an expanding library of over 150 citations in popular databases in the past quarter century.

  Despite underreporting, the condition still accounted in the 1990s for 32% of reported UK illness associated with fish/shellfish[3] and 50% in the USA[4] and is credited with about 5% of USA food-borne illness.[5] As noted in this latest report, even with all the publicity, the condition is often misdiagnosed. It seems that case reports, which in this case add no new evidence to the current knowledge base, are not sufficiently effective in keeping clinicians aware of the condition.

  To demonstrate this, consider the report of two anaphylaxis- associated deaths in asthmatic children, by Rainbow et al, a few pages away in the same issue of the Emergency Medical Journal.[6] The first case is of an asthmatic child who died, despite resuscitation attempts, from a suspected anaphylactic reaction after eating a meal of seafood. The authors note, however, that no definite trigger for anaphylaxis was identified on RAST testing for crab, chicken and peanut. The mast cell tryptase levels measured were within normal limits, not suggestive of an anaphylactic reaction. And yet, food-borne amine poisoning seems not to have been considered, despite having been previously reported with both crab and chicken.[7] Had an assay of the implicated food been conducted, yielding a positive result, it could have been a potential opportunity to double the number of reported deaths[4] from the condition.

  In 1973, a single mackerel-related outbreak resulted in 2656 known cases.[7] One hopes that early recognition and notification might nip the next potential major incident in the bud. Indeed, prevention seems to be the only current option for improving outcomes. As this condition is worth repeated mention then perhaps it merits a place as a step in anaphylaxis management algorithms and their instruction.

  References

  (1) Attaran RR, Probst F. Histamine fish poisoning: a common but frequently misdiagnosed condition. Emergency Medicine Journal 2002; 19(5): 474-475

  (2) Stell IM. Trouble with tuna: two cases of scombrotoxin poisoning. Journal of Accident & Emergency Medicine 1997; 14(2): 110-111

  (3) Gillespie IA, Adak GK, O'Brien SJ. General outbreaks of infectious intestinal disease associated with fish and shellfish, England and Wales, 1992-1999. Communicable Disease & Public Health 2001; 4(2): 117-123

  (4) Lehane L, Olley J. Histamine fish poisoning revisited. International Journal of Food Microbiology 2000. 58(1-2): 1-37

  (5) Patrick JD. Toxicity, scombroid. http://www.eMedicine.com

  (6) Rainbow J, Browne GJ. Fatal asthma or anaphylaxis? Emergency Medicine Journal 2002; 19(5): 415-417

  (7) Taylor SL. Histamine food poisoning: toxicology and clinical aspects. Critical Reviews in Toxicology 1986; 17(2): 91-128

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  Conflict of Interest:
  None declared.

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