Dr. Muhlfelder presents today’s Morning Report!
SCROMBOID
The “seafood allergy”/ Histamine Toxicity
- Significantly underreported-misdiagnosed as seafood allergy
- Contaminated dark meat fish i.e. tuna, mackerel, skip-jack and bonito (name derived from Scromdroidea class of fish initially associated with illness)
- Less likely, but reported: mahi mahi, swordfish, sardines, salmon AND contaminated SWISS CHEESE!
- In US, mostly recreational fish catches with improper storage/freezing to <38 F
- With bacterial overgrowth histidine is converted to histamine, completed by a decarboxylase found within E.coli, Vibrio, Proteus, Klebsiella, Morganella morganii, Salmonella and Shigella
- Not eradicated with cooking, freezing
- Described as peppery, spicy, bubbly
Presentation:
- Rapid onset of flushing, urticarial rash w/ prominence on trunk and face, headache, diarrhea
- Perioral burning/itch, uncomfortable sensation of warmth, dizziness, palpitations, tachycardia
- Increased concern in pts with underlying pulmonary disease, or on isoniazid (inhibits histamine metabolism)
- Rarely pt presents with upper airway edema, hypotension or bronchospasm- which should warrant anaphylaxis therapy
- Can present as multiple pt’s with same symptoms
- Improves rapidly w anti-histamine therapy
- Treatment: supportive care, H1 (Benadryl or hydroxyzine) or H2 (ranitidine or cimetidine) antagonists, loratadine, cetirizine
- Recurrence reaction from continued toxin absorption from GI tract
Similar presentations:
- #1 food allergy in US, IgE mediated- shellfish
- Ciguatera poisoning from toxin ingested by carnivorous reef fish (barracuda, moray eel, grouper..)
- GI complaints + Neuro symptoms: paresthesias, transient blindness/blurred vision, cold allodynia
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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