Scombrotoxic fish poisoning

Scombrotoxic fish poisoning (SFP) is associated with the consumption of contaminated fish of the Scombroid family (including tuna, mackerel, herring, marlin, bonito and jacks). SFP is a chemical intoxication and symptoms occur within 10 minute to 2 h after consumption of preformed histamine in scombroid fish and include rash on the face, neck and upper chest, flushing, sweating, nausea, vomiting, diarrhoea, abdominal cramps, headache, dizziness, palpitations, oral burning sensation, metallic taste and hypotension. Symptoms usually resolve within 24 h. Although most cases do not seek medical attention, in some instances symptoms may be of sufficient severity to prompt cases to seek urgent medical attention, where antihistamine drugs may be used. Scombroid fish naturally contain high levels of histidine which is converted to toxic histamine as a result of histidine decarboxylase-producing bacteria if storage conditions are inadequate to control bacterial growth (Fig. 1). Histamine is heat stable and survives subsequent processing, including canning, and ingestion of fish with histamine at levels in excess of 1000 ppm (100 mg/100 g) can result in illness. Bacterial spoilage and production of histamine may occur at any stage in the food chain (i.e. from landing the fish, at the processing plant or in the distribution system or in catering premises or homes) and adequate temperature control is key in preventing bacterial growth and histamine formation. For control of fish belonging to the scombroid family the permissible level set by EU legislation for each batch of fish is an average histamine concentration lower than 100 ppm (10 mg/100 g).1