Scombroid fish poisoning is a toxic reaction that occurs from eating poorly stored dark meaty fish (such as tuna, mackerel, mahi-
mahi, kingfish, sardine, and anchovy).   Scombroid fish poisoning can occur if fish is poorly refrigerated from the time it is fished
until it reaches your dinner plate.   When this happens, bacteria can grow and produce a toxin called scombrotoxin which contains
histamine.    When the fish is cooked, the bacteria will be killed but the toxin (and thus histamine) will still be present.    Ingesting
fish meat containing the toxin will result in becoming ill.   As the amount of toxin varies from fish to fish and from parts of the fish to
other parts, some individuals at the dinner table may get sick while others may feel perfectly fine.

What are the symptoms of scombroid poisoning?
Symptoms usually start with a sensation of warmth and flushing, followed by a red, hot, itchy rash which often appears on the face,
neck, chest, and upper back.    This can be accompanied by a burning sensation in the mouth, a peppery or metallic taste in the
mouth, a pounding headache, abdominal cramps, diarrhea, difficulties breathing, and dizziness.  Symptoms can develop within
minutes of eating the fish or take 1 hour to 2 hours to develop.   Usually, the symptoms resolve within 3-8 hours on their own.   
Antihistamines (Benadryl, Claritin, Allegra, Zyrtec,…) often make the symptoms go away much quicker.   Severe reactions may
need to be treated in an emergency room.

Is Scombroid poisoning an allergic reaction?
No, Scombroid poisoning is a food intolerance, not a food allergy.   Scombroid poisoning develops because of the ingestion of a
large amount of toxin (histamine) from poorly preserved fish.     This compares to allergic reactions which develop when your body’
s immune system abnormally reacts to certain proteins in fish that it believes are harmful.      During allergic reactions, the body
will release histamine (and other chemicals) in the blood stream which will cause allergy symptoms to develop.   Scombroid
poisoning is often confused with a food allergy since histamine is involved in both reaction and the symptoms can be similar.

Do I need to stop eating fish if I had scombroid poisoning?
Individuals who have had scombroid poisoning do not need to avoid fish again, but care must be taken to ensure that the fish has
been well preserved prior to consumption.    If it is uncertain whether the reaction that occured was scombroid poisoning or an
allergic reaction, it is recommended to get evaluated by a board certified allergist before eating more fish.
Scombroid Poisoning

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