30 y.o female presents feeling warm and flushed, followed by a diffuse throbbing headache.  She also has developed diarrhea. This all started about one hour after eating dinner with her husband.  He had prepared tuna for her at home and she did notice a “peppery” taste to the fish. You correctly identify a scombroid poisoning!

What causes scombroid poisoning?

Fish are improperly stored at some point after being caught. The fish then have bacterial overgrowth and histidine is converted to histamine. Cooking, freezing or refrigeration does not reverse this process or break down the histamine. It typically occurs in dark meat fish such as tuna, mackerel or skip-jack

What are the symptoms?

Usually flushing, warmth, headache and diarrhea although more serious symptoms can result

So how do I treat it?

This usually self resolves in 12 - 24 hours, but symptoms can rapidly improve with anti-histamines!

If any signs of airway involvement or hypotension, treat as anaphylaxis.

References

Up to Date. Scombroid (histamine) poisoning. Erin Marcus, MD ,MPH, FACP. July 2017.