Scombroid Toxicity Medication

  • Author: John D Patrick, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 4, 2012
 

Medication Summary

If the patient is symptomatic enough to require treatment, antihistamines are used to counteract the excessive histamine-induced effects; H1- and H2-blockers may be useful. Epinephrine or other adrenergic agents are rarely necessary because the entire cascade of mediators released by a true allergic reaction is not found in scombroid poisoning. Blockade of histamine, the sole pharmacologic mediator of scombrotoxism symptoms, generally is the only treatment necessary. Adrenergic agents may be considered in the rare case of secondary bronchospasm or refractory hypotension associated with this type of poisoning.

Next

Antihistamines

Class Summary

These agents directly counteract the symptom-causing histamine excess.

View full drug information

Diphenhydramine (Benadryl)

 

Oral or IV H1-receptor antagonists are DOC. Other antihistamines also may be used.

View full drug information

Cimetidine (Tagamet)

 

H2-receptor antagonist that may be used in conjunction with H1-blockers for severely symptomatic cases.

View full drug information

Ranitidine (Zantac)

 

H2-receptor antagonist may be used in conjunction with H1-blockers for severely symptomatic cases. Has fewer drug interactions than cimetidine and may be better for patients who take other medications metabolized by the cytochrome p450 system.

Previous
Next

Beta2-adrenergic Agonist Agent

Class Summary

Relaxes bronchial smooth muscle by action on beta2-receptors.

View full drug information

Albuterol (Proair HFA, Proventil, Ventolin)

 

Beta-agonist used for bronchospasm. Stimulates adenyl cyclase to convert ATP to cAMP and causes bronchodilation. Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility. May decrease mediator release from mast cells and basophils and inhibit airway microvascular leakage.

Frequency may be increased. Institute regular schedule in patients on anticholinergic drugs who remain symptomatic. Available as liquid for nebulizer, MDI, and dry powder inhalers.

Previous
Next

Anticholinergic Agent

Class Summary

Quaternary ammonium anticholinergic bronchodilator. Synergistic when used with beta2-agonist.

View full drug information

Ipratropium (Atrovent)

 

A quaternary ammonium anticholinergic bronchodilator acting at muscarinic receptors of the parasympathetic nervous system. Chemically related to atropine. Has antisecretory properties and, when applied locally, inhibits secretions from serous and seromucous glands lining the nasal mucosa.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

John D Patrick, MD  Assistant Professor of Medicine, Division of Emergency Medicine, Harvard Medical School; Staff, Walk-In Center, Mount Auburn Hospital

John D Patrick, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Feldman KA, Werner SB, Cronan S, Hernandez M, Horvath AR, Lea CS. A large outbreak of scombroid fish poisoning associated with eating escolar fish (Lepidocybium flavobrunneum). Epidemiol Infect. Feb 2005;133(1):29-33. [Medline].

  2. Lynch M, Painter J, Woodruff R, Braden C. Surveillance for foodborne-disease outbreaks--United States, 1998-2002. MMWR Surveill Summ. Nov 10 2006;55(10):1-42. [Medline]. [Full Text].

  3. Al Bulushi I, Poole S, Deeth HC, Dykes GA. Biogenic amines in fish: roles in intoxication, spoilage, and nitrosamine formation--a review. Crit Rev Food Sci Nutr. Apr 2009;49(4):369-77. [Medline].

  4. Hungerford JM. Scombroid poisoning: a review. Toxicon. Aug 15 2010;56(2):231-43. [Medline].

  5. Taylor SL, Stratton JE, Nordlee JA. Histamine poisoning (scombroid fish poisoning): an allergy-like intoxication. J Toxicol Clin Toxicol. 1989;27(4-5):225-40. [Medline].

  6. Russell FE, Maretic Z. Scombroid poisoning: mini-review with case histories. Toxicon. 1986;24(10):967-73. [Medline].

  7. Scombrotoxin (Histamine) Formation (A Chemical Hazard) - 3rd Edition. US Food and Drug Administration. Available at http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/Seafood/FishandFisheriesProductsHazardsandControlsGuide/ucm091910.htm. Accessed March 31, 2012.

  8. Ricci G, Zannoni M, Cigolini D, Caroselli C, Codogni R, Caruso B. Tryptase serum level as a possible indicator of scombroid syndrome. Clin Toxicol (Phila). Mar 2010;48(3):203-6. [Medline].

  9. Grinda JM, Bellenfant F, Brivet FG, et al. Biventricular assist device for scombroid poisoning with refractory myocardial dysfunction: a bridge to recovery. Crit Care Med. Sep 2004;32(9):1957-9. [Medline].

  10. Bean NH, Goulding JS, Lao C, Angulo FJ. Surveillance for foodborne-disease outbreaks--United States, 1988-1992. MMWR CDC Surveill Summ. Oct 25 1996;45(5):1-66. [Medline].

  11. Bedry R, Gabinski C, Paty MC. Diagnosis of scombroid poisoning by measurement of plasma histamine. N Engl J Med. Feb 17 2000;342(7):520-1. [Medline].

  12. Bjeldanes LF, Schutz DE, Morris MM. On the aetiology of scombroid poisoning: cadaverine potentiation of histamine toxicity in the guinea-pig. Food Cosmet Toxicol. Apr 1978;16(2):157-9. [Medline].

  13. Centers for Disease Control and Prevention. Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. Aug 17 2007;56(32):817-9. [Medline]. [Full Text].

  14. Chin KW, Garriga MM, Metcalfe DD. The histamine content of oriental foods. Food Chem Toxicol. May 1989;27(5):283-7. [Medline].

  15. Eckstein M, Serna M, DelaCruz P, Mallon WK. Out-of-hospital and emergency department management of epidemic scombroid poisoning. Acad Emerg Med. Sep 1999;6(9):916-20. [Medline].

  16. Ferran M, Yebenes M. Flushing associated with scombroid fish poisoning. Dermatol Online J. 2006;12(6):15. [Medline]. [Full Text].

  17. Kipping R, Eastcott H, Sarangi J. Tropical fish poisoning in temperate climates: food poisoning from ciguatera toxin presenting in Avonmouth. J Public Health (Oxf). Dec 2006;28(4):343-6. [Medline].

  18. Leask A, Yankos P, Ferson MJ. Fish, so foul! Foodborne illness caused by combined fish histamine and wax ester poisoning. Commun Dis Intell. 2004;28(1):83-5. [Medline].

  19. Lehane L, Olley J. Histamine fish poisoning revisited. Int J Food Microbiol. Jun 30 2000;58(1-2):1-37. [Medline].

  20. Lipp EK, Rose JB. The role of seafood in foodborne diseases in the United States of America. Rev Sci Tech. Aug 1997;16(2):620-40. [Medline].

  21. McInerney J, Sahgal P, Vogel M, et al. Scombroid poisoning. Ann Emerg Med. Aug 1996;28(2):235-8. [Medline].

  22. Mines D, Stahmer S, Shepherd SM. Poisonings: food, fish, shellfish. Emerg Med Clin North Am. Feb 1997;15(1):157-77. [Medline].

  23. Molinari G, Montagnoli G, Pellegrini G, Caroli G. [Hygiene and health importance of histamine as an unhealthy factor in several food products]. Ann Ig. May-Aug 1989;1(3-4):637-46. [Medline].

  24. Morii H, Kasama K, Herrera-Espinoza R. Cloning and sequencing of the histidine decarboxylase gene from Photobacterium phosphoreum and its functional expression in Escherichia coli. J Food Prot. Aug 2006;69(8):1768-76. [Medline].

  25. Morrow JD, Margolies GR, Rowland J, Roberts LJ 2nd. Evidence that histamine is the causative toxin of scombroid-fish poisoning. N Engl J Med. Mar 14 1991;324(11):716-20. [Medline].

  26. Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. Feb 15 2004;69(4):885-90. [Medline].

  27. Predy G, Honish L, Hohn W, Jones S. Was it something she ate? Case report and discussion of scombroid poisoning. CMAJ. Mar 4 2003;168(5):587-8. [Medline]. [Full Text].

  28. Sims JK. A theoretical discourse on the pharmacology of toxic marine ingestions. Ann Emerg Med. Sep 1987;16(9):1006-15. [Medline].

  29. Smart DR. Scombroid poisoning. A report of seven cases involving the Western Australian salmon, Arripis truttaceus. Med J Aust. Dec 7-21 1992;157(11-12):748-51. [Medline].

  30. Stommel EW, Watters MR. Marine Neurotoxins: Ingestible Toxins. Curr Treat Options Neurol. Mar 2004;6(2):105-114. [Medline].

  31. Taylor SL. Histamine food poisoning: toxicology and clinical aspects. Crit Rev Toxicol. 1986;17(2):91-128. [Medline].

  32. Uragoda CG. Histamine poisoning in tuberculous patients after ingestion of tuna fish. Am Rev Respir Dis. Jan 1980;121(1):157-159. [Medline].

 
Previous
Next
 
An example of a typical scombroid rash, in this case from tuna. Image courtesy of Amanda Oakley, MBChB, FRACP.
An example of a typical scombroid rash, in this case from tuna. Posterior view of the same patient as in the image above. Image courtesy of Amanda Oakley, MBChB, FRACP.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.