Scombroid fish poisoning

Several taxa of Enterobacteriaceae inclnding Morganella morganii, Proteus vulgaris, and Raoultella (Klebsiella) planticola are able to decarboxylate the amino acid histidine, which is abundant in the mnscle tissne of scombroid hsh (Yoshinaga and Frank 1982 Takahashi et al. 2003). The histamine produced has been associated with an incident of scombroid fish poisoning (Taylor et al. 1989). 

Taylor SL, JE Stratton, JA Nordlee (1989) Histamine poisoning (scombroid fish poisoning) an allergy-like intoxication. Clin Toxicol 27 225-240. 

Taylor, S., Guthertz, L.S., Leatherwood, M. and Lieber, E.R. (1979). Histamine production by Klebsiella pneumoniae and an incident of scombroid fish poisoning, Appl. Env. Microbiol., 37, 274. 

Adverse effects of histamine release, like those following administration of histamine, are dose-related. Flushing, hypotension, tachycardia, headache, wheals, bronchoconstriction, and gastrointestinal upset are noted. These effects are also observed after the ingestion of spoiled fish (scombroid fish poisoning), and there is evidence that histamine produced by bacterial action in the flesh of the fish is the major causative agent. 

Toxins (bacterial contamination, scombroid fish poisoning)... 

Scombroid fish poisoning, associated with facial flushing, hives, and general itching, is caused by the ingestion of inadequately refrigerated fish, typically mahimahi (pictured) and tuna. Bacteria convert the amino acid histidine (Chapter 28) to histamine, which, when consumed in large amounts, results in this clinical syndrome. 

Anon (2000) Scombroid fish poisoning - Pennsylvania, 1998. Morbidity and Mortality Weekly Report 49 398-400. 

Morrow JD, Margolies GR, and Rowland J (1991) Evidence that histamine is the causative toxin of scombroid-fish poisoning. New England Journal of Medicine 324 716-720. 

Taylor, S. L., Stratton, J. E., and J. A. Nordlee. (1989). Histamine poisoning (Scombroid fish poisoning) An Allergy-like intoxication. Clin. Toxicol. 27, 225-240. 

I. Pharmacology. Cimetidine, ranitidine, famotidine, and nizatidine are selective competitive inhibitors of histamine on Hj receptors. These receptors modulate smooth muscle, vascular tone, and gastric secretions and may be involved in clinical effects associated with anaphylactic and anaphylactoid reactions, as well as ingestion of histamine or histamine-like substances (eg, scombroid fish poisoning). Cimetidine, as an inhibitor of cytochrome P-450 enzymes, has been proposed or studied in animals as an agent to block the production of toxic intermediate metabolites (eg, acetaminophen, carbon tetrachloride, halothane. 

B. Adjunctive with blockers such as diphenhydramine (see p 436) in the management of scombroid fish poisoning (p 205). 

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