We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Scombroid
From WikEM
Contents
Background
- Caused by eating fish which have been improperly stored/refrigerated
- Bacteria grow and produce heat-stable toxin that causes histamine release when consumed[1]
- Patient may complain that the fish tasted like pepper, metallic, or bitter
- Commonly associated fish include: tuna, bluefish, mahi-mahi, herring, mackerel, skip-jack, sardine, and bonito
- Frequently misdiagnosed as seafood allergy
Clinical Features
- Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
- Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea
- May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress
Differential Diagnosis
- Ciguatera - similar clinical presentation, different fish
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Asthma exacerbation
- Anxiety attack
- Scombroid
- Cold urticaria
- Contrast induced allergic reaction
- Shock
- Transfusion reaction
- Carcinoid syndrome
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
- Anaphylaxis
- Scombroid
- Alcohol intoxication
Evaluation
- Generally clinical diagnosis
Management
- Antihistamines - give both H1 and H2 antagonists
- Consider epinephrine, albuterol if symptoms of respiratory distress
Disposition
- Generally may be discharged
See Also
References
- ↑ Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222
