Tilapia Consumption and Scombroid Poisoning

Abstract

Scombroid poisoning, also known as histamine fish poisoning, typically occurs after eating dark meat fish. Higher levels of histidine, which is converted to histamine, causes anaphylaxis-like symptoms upon ingestion. There are few reported cases of scombroid in humans secondary to light meat fish. We present a case secondary to tilapia consumption.

Scombroid Poisoning

“…Fish levels of histamine of 5 mg/100 g are considered normal and acceptable for human consumption in the United States and 10 mg/100 g in the United Kingdom (Gonzalez, et al, 2021). Fish with elevated levels of histamine that can lead to scombroid poisoning may not appear, smell, or taste abnormal (Edigin, Lingamaneni, Sarmiento, Shaka, & Patel, 2019).…”

“…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). In severe cases, patients may develop respiratory symptoms such as wheezing, angioedema, bronchospasm, hypotension, and respiratory distress (Guergué-Díaz de Cerio et al, 2016; Nordt & Pomeranz, 2015).…”

The Sea Was Angry That Day My Friends: An Inland Case of Acute Scombroid Poisoning With a Twist

“…However, various families of fish and cheeses that contain elevated levels of histamine and other products of decomposition have been implicated [ 2 ]. The fish itself must be stored at temperatures less than 40 degrees Fahrenheit from catch until it is prepared for human consumption to avoid an irreversible chemical process that results in histamine formation which may occur even with cooking, so prevention with proper handling is key [ 3 ]. A typical presentation of scombroid poisoning usually involves a relatively rapid onset of symptoms within 20-30 minutes and lasts for 4-48 hours [ 3 ].…”

“…The fish itself must be stored at temperatures less than 40 degrees Fahrenheit from catch until it is prepared for human consumption to avoid an irreversible chemical process that results in histamine formation which may occur even with cooking, so prevention with proper handling is key [ 3 ]. A typical presentation of scombroid poisoning usually involves a relatively rapid onset of symptoms within 20-30 minutes and lasts for 4-48 hours [ 3 ]. The cause appears to be somewhat simple on the surface but may also be a complex interplay of factors.…”

“…Patients can additionally have abdominal cramps, blurred vision, nausea, and sweating. There is a concern in these presentations for overlap with anaphylaxis and the clinician should be aware to look for evidence of airway edema, bronchospasm, tongue swelling, respiratory distress, or hypotension [ 3 ]. Patients typically improve rather quickly with antihistamine medications and the overall prognosis is very good without chronic sequelae in the vast majority of cases [ 3 ].…”