Adult-Onset Mast Cell Activation Syndrome Following Scombroid Poisoning a case report and review of the literature

Abstract

Mast Cell Activation syndrome (MCAS) is a clinical condition, defined by the combination of 1) typical symptoms, 2) laboratory abnormalities and 3) response to treatment. Patients present with episodic symptoms of aberrant mast cell activation, such as abdominal cramping, asthma, hypotensive episodes, tachycardia, anaphylaxis, unexplained arrhythmias, and neurologic/psychiatric symptoms. Both clonal and nonclonal mast cell activation syndromes have been described, with a greater prevalence of non-clonal MCAS among the pediatric and adult population. Numerous extrinsic triggers of mast cell activation (MCA) are described, but recent reports point to nonatopic triggers, as the predominant, extrinsic stimulants of MCA in the adult population. The etiology of MCAS is unclear, though recent studies point to the disruption of the epithelium by infection, toxic exposures or physical trauma, and perturbation the tight regulation of these innate immune cells, associated to the epithelial borders. Here we describe a geriatric patient with adult onset MCAS, following a significant toxic exposure, scombroid poisoning. We also review the relevant literature regarding MCAS diagnosis and management as well as potential mechanisms for this hypersensitivity syndrome in adults.

Scombroid Poisoning

“…Symptoms may start from 10 min to an hour after fish consumption. In addition, unlike fish allergy, scombroid affects more than one person who have consumed the contaminated fish simultaneously, which is unlikely to occur in fish allergy (Brock et al, 2021). Patients may rarely report a peppery or spicy taste to the fish (Edigin et al, 2019).…”

“…Fish allergy typically involves an IgE-mediated response, whereas scombroid is due to the release of histamine from the flesh of the fish (Feng et al, 2015; Gonzalez et al, 2021). The initial presentation of scombroid poisoning can mimic an IgE-mediated response with symptoms such as, hives, rash, nausea, facial swelling, diarrhea, and flushing, unlike an IgE-mediated response anxiety is less frequently observed (Brock, Eng, & Maitland, 2021). Typically, the symptoms of scombroid poisoning will present within 10 min to 1 hr following the consumption of toxic fish (Brock et al, 2021).…”

“…The initial presentation of scombroid poisoning can mimic an IgE-mediated response with symptoms such as, hives, rash, nausea, facial swelling, diarrhea, and flushing, unlike an IgE-mediated response anxiety is less frequently observed (Brock, Eng, & Maitland, 2021). Typically, the symptoms of scombroid poisoning will present within 10 min to 1 hr following the consumption of toxic fish (Brock et al, 2021). Symptoms unique to scombroid poisoning following consumption of infected fish are peppery or metallic taste in the mouth, oral numbness, headache, dizziness, and possibly a rapid and weak pulse (Brock et al, 2021).…”

“…Typically, the symptoms of scombroid poisoning will present within 10 min to 1 hr following the consumption of toxic fish (Brock et al, 2021). Symptoms unique to scombroid poisoning following consumption of infected fish are peppery or metallic taste in the mouth, oral numbness, headache, dizziness, and possibly a rapid and weak pulse (Brock et al, 2021). Scombroid differs entirely from other fish-borne illnesses as it is entirely preventable with proper storage and preparation.…”

Mast Cell Activation Syndromes: Collegium Internationale Allergologicum Update 2022

“…MCA may occur in a number of different physiologic and pathologic conditions. Acute MCA is commonly seen in various allergic reactions, other hypersensitivity reactions (e.g., intolerance) and toxic reactions against exogenous elicitors, such as venoms [4,8,9,[19][20][21][22][23]29]. The most common underlying condition is an overt IgEdependent allergic disorder.…”