Scombroid Toxicity Workup

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

Laboratory Studies

Generally, the diagnosis of scombroid toxicity is clinical; no laboratory tests are necessary. It can sometimes be difficult to distinguish a true food allergy from scombrotoxism, especially in isolated cases. The absence of any history of allergic reactions to the same food, especially if combined with a cluster of cases associated with eating the same meal, can be helpful in making this distinction, since these would suggest a diagnosis of scombroid toxicity. One recent study has suggested that serum tryptase levels, if obtained very early (1-2 h from symptom onset), may also help to make this determination; if tryptase levels are elevated, an allergic reaction is more likely, since the tryptase level is usually within the normal range in histamine food poisoning.[8]

If the diagnosis requires confirmation, histamine levels can be measured in a piece of frozen suspect fish.[4, 7]

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Other Tests

  • In patients in whom palpitations are a predominant symptom, an ECG may be necessary.
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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

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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.
 
 
 
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