Scombrotoxinism: Protracted Illness following Misdiagnosis in the Emergency Department

Lohiya, Ghan-Shyam; Lohiya, Sapna; Lohiya, Sunita; Krishna, V. N. Vamsi

doi:10.1155/2015/597934

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Estos síntomas varían por los diferentes tipos de receptores para histamina (H1, H2, H3, H4). H1 y H2 median la respuesta cardiovascular, así como el prurito, urticaria y enrojecimiento; los receptores H3 modulan la liberación de neurotransmisores en el sistema nervioso central y son causantes de cefalea, náusea y vómito [7]. La diamina oxidasa (DAO) y la histamina Nmetil transferasa (HNMT) son enzimas que metabolizan la histamina en humanos, por tal motivo la inhibición de estas enzimas puede potenciar los efectos de la histamina, ya que aumenta su absorción intestinal y previene el metabolismo extraintestinal.…”

Section: Discussionunclassified

Intoxicación por histamina: del rash al shock. Revisión de un caso de escombroidosis desde la perspectiva de los cuidados críticos

Mora-Aznar¹,

Molina-Torres²

2023

Rev. chil. anest.

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Section: Discussionunclassified

Intoxicación por histamina: del rash al shock. Revisión de un caso de escombroidosis desde la perspectiva de los cuidados críticos

Mora-Aznar¹,

Molina-Torres²

2023

Rev. chil. anest.

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“…There are two reports of patients developing chronic mast cell activation disorders following scombroid poisoning: after ingesting decomposed tuna, a 21-year-old woman, with a history of intermittent asthma, developed poorly controlled asthma, requiring multiple ED visits and five daily medications to control new onset, severe persistent asthma. Another woman, without a history of MCADs, was diagnosed with adult-onset rhinitis and asthma following scombroid poisoning [7 , 8] .…”

Section: Discussionmentioning

confidence: 99%

Adult-onset mast cell activation syndrome following scombroid poisoning: a case report and review of the literature

2021

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Background Mast cells are closely associated with epithelium, serving as sentinels responsible for the recognition of tissue injury and coordination of the initial inflammatory response. Upon detection of the injured cell content, mast cells then tailor the release of preformed and newly produced chemical mediators to the detected challenge, via an array of pathogen receptors. In addition to immunoglobulin E receptor-triggered mast cell activation, commonly referred to as allergic or atopic disorders, non-immunoglobulin E receptor mediated mast cell activation follows engagement of toll-like receptors, immunoglobulin G receptors, and complement receptors. Upon containment of the extrinsic challenge, acute inflammation is downregulated, and repair of the injured tissue ensues. The mast cell compartments must return to a baseline steady state to remain tolerant towards self-antigens and harmless entities, including environmental conditions, to prevent unnecessary immune activation and chronic hypersensitivity disorders. Over the past 50 years, an increasing number of patients are experiencing episodes of aberrant mast cell activation, not associated with allergen-specific mast cell disease or systemic mastocytosis. This led to proposed diagnostic criteria of mast cell activation syndrome. Mast cell activation syndrome is a heterogeneous disorder, defined by a combination of (1) recurrent symptoms typical of mast cell activation, (2) an increase of validated mast cell derived mediators, and (3) response to treatment with mast cell stabilizing or mast cell mediator-targeted therapies. Onset of mast cell activation syndrome ostensibly reflects the loss of tolerance in the mast cell compartment to nonthreatening entities and nonhazardous environmental conditions. The etiology of chronic mast cell dysregulation and associated intolerance to self-antigens or harmless entities is not well understood, but a growing number of studies point to exposure of the epithelial borders, which leads to inappropriate or excessive mast cell activation or impaired resolution of acute inflammation following neutralization of the identified pathogen. Case presentation Here we present a case of adult onset mast cell activation syndrome following scombroid poisoning. Scombroid toxicity is usually a self-limited illness, but there are individuals who have been shown to have severe symptoms or persistent illness following histamine fish poisoning. We describe a 74-year-old Caucasian woman, with a history of drug-induced urticaria, who developed a constellation of hypersensitivity illnesses consistent with the diagnosis of mast cell activation syndrome after ingestion of tainted fish. Conclusion Mast cell activation disease causes problems of increased complexity in children and adults. The increased prevalence and severity of mast cell activation disease has been attributed to dramatic changes in our lifestyles and modern living environments. These changes likely impact the integrity of the epithelial barriers, leading to loss of tolerance in the mast cell compartment. Here, we present a case of a nonatopic, 74-year-old female who developed mast cell activation disease after exposure to a potent environmental toxin. Mast cell activation disease commonly involves several organ systems, with patients often referred to a succession of different specialists. This results in delayed diagnosis and suboptimal care. Instead, early recognition of mast cell activation disease would lead to better outcomes. We review the literature, describing the diagnostic criteria for mast cell activation disorders that can improve recognition of this multiorgan system syndrome. Further research is needed into the interaction of epithelial barrier disruption and the dysregulation of the immune system.

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“…There are two reports of patients developing chronic mast cell activation disorders, following scombroid poisoning: after ingesting decomposed tuna, a 21-year old woman, with a history of intermittent asthma, developed not well controlled asthma, requiring multiple ED visits and 5 daily medications, to control new onset, severe persistent asthma. Another woman, without a history of MCADs, was diagnosed with adult-onset rhinitis and asthma, following scombroid poisoning 12,13 .…”

Section: Discussionmentioning

confidence: 99%

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

Brock

Eng

Maitland

2021

Preprint

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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.

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Scombrotoxinism: Protracted Illness following Misdiagnosis in the Emergency Department

Cited by 8 publications

References 6 publications

Intoxicación por histamina: del rash al shock. Revisión de un caso de escombroidosis desde la perspectiva de los cuidados críticos

Intoxicación por histamina: del rash al shock. Revisión de un caso de escombroidosis desde la perspectiva de los cuidados críticos

Adult-onset mast cell activation syndrome following scombroid poisoning: a case report and review of the literature

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

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