Scombroid fish poisoning in Israel, 2005-2007.
BACKGROUND
Scombroid fish poisoning is an acute illness caused by consumption of fish containing high concentrations of histamine. Improper handling of fish leads to bacterial contamination. Bacterial enzymes convert histidine to histamine. Symptoms develop quickly and resemble an immunoglobulin E-mediated allergic reaction. The diagnosis is often missed. Serious complications (e.g., bronchospasm, hypotension) are infrequent.


OBJECTIVE
To evaluate the prevalence and characteristics of scombroid fish poisoning in Israel as reported to the national poison information center.


METHODS
We conducted a retrospective poison center chart review from January 2005 to December 2007.


RESULTS
During the study period, 21 events of scombroid poisoning involving 46 patients were recorded. Tuna was the commonest fish consumed (84.7%). Clinical manifestations developed within 20 minutes in 65.2% of the patients. The main clinical manifestations included rash (41%), flushing (37%), gastrointestinal complaints (37%) and headache (30.4%). About 25% had abnormal vital signs; two patients developed hypotension. Treatment was supportive and included mainly H1-antagonists (65.2%) and fluids (13%). Five patients were initially misdiagnosed as having an allergic reaction and were treated with corticosteroids (four patients) and epinephrine (one patient).


CONCLUSIONS
Scombroid fish poisoning should be suspected in patients with histamine-like manifestations that are temporally related to fish (mainly tuna) consumption, especially in outbreaks. Although scombroid poisoning is often self-limited and responds well to antihistamines, prolonged observation may be required as severe toxicity can supervene. Proper handling of fish and urgent notification of the Ministry of Health are mandatory in order to prevent this potentially serious public heath problem.
Lavon
Ophir
O
Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.
Lurie
Yael
Y
Bentur
Yedidia
Y
D000293:Adolescent; D000328:Adult; D000818:Animals; D016009:Chi-Square Distribution; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008387:Marine Toxins / Q000506:poisoning*; D008875:Middle Aged; D012189:Retrospective Studies; D017747:Seafood / Q000506:poisoning*; D012720:Severity of Illness Index; D055815:Young Adult
D008387:Marine Toxins; C034101:scombrotoxin