A family obtained tuna from the local farmer’s market and prepared it for dinner. The children thought the fish tasted weird, peppery or metallic, but the parents did not, and told the children to stop complaining and eat dinner. Within 20 minutes of consumption, the children complain of headache, dizziness, pruritis, abdominal cramping, and nausea. They appear somewhat flushed in the face, neck, and chest.
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September 12, 2017 at 5:30 pm
B. Histamine in the fish
These children have histamine fish poisoning, previously called scombroid as it is associated with consumption of fish from the order Scombridae, including mackeral, tuna, marlin, swordfish, albacore, bonito. However, numerous other fish can cause it, many non-scombroid, such as mahi-mahi, amberjack, herring, sardine, anchovy, bluefish. Improperly refrigerated fish means that bacteria multiply, and the bacteria contain histidine decarboxylase, which converts histidine to histamine in the fish. Symptoms occur within 15-30 minutes of ingestion, and include throbbing headache, skin flushing of the top half of the body, pruritis, and gastrointestinal symptoms. Histamine fish poisoning occurs worldwide and accounts for 40% of seafood-related foodborne illness. Because histamine can be concentrated in one part of the fish, some family members can be affected when others aren’t. Most cases are self-limited and resolve in 6 hours. Treat with anti-histamines and IV fluids /other anti-anaphylaxis treatments as needed.