Search

The most common type of fish poisoning is caused by eating spoiled tuna, bonito, mackerel and other scombroid fish (scombrotoxism). Other fish, including mahi-mahi, bluefish, amberjack, herring, sardines, and anchovies have caused scombrotoxism, as has cheese on rare occasions. This is one of the major chemical food-borne illnesses in the United States, according to the Centers for Disease Control, and can be prevented by proper handling and refrigeration of the fish. If the fish becomes warm at any time after it is caught, bacteria thrive and poisoning can occur even though the fish looks and smells fresh. Symptoms begin within an hour of eating the fish, and include flushing, sweating, digestive upset, headache, palpitation, dizziness, rash, and sometimes swelling of the face and tongue. Occasionally respiratory distress can occur. Histamine has been suspected as the cause for almost 50 years, but proof was lacking because it did not produce illness when given to healthy subjects. By measuring the urinary levels of histamine in three subjects with fish poisoning, it was found that the levels were much greater than those caused by histamine excess. It seems that the histamine came from the fish (marlin), and was not the result of excessive release of histamine from body tissues. Whether histamine is in the fish or released by the body, histamine is the cause. This finding should be the basis for a general public health policy recommendation that scombroid poisoning should be treated with an antihistamine, specifically, antagonists to both H1 and H2 receptors in combination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Food-borne illness caused by infectious organisms and chemical poisons are still a public health problem despite advances in sanitation. Between 1973 and 1987, 2,841 outbreaks of food-borne disease, involving 124,994 cases, were reported to the Centers for Disease Control. Most cases were bacterial, but almost 700 outbreaks were caused by chemical agents. Scombroid-fish poisoning was among the most common of causes, along with ciguatera, caused by contaminated fish in the Caribbean and the South Pacific. The paper by Jason D. Morrow and his colleagues in the March 14, 1991 issue of The New England Journal of Medicine, presents the results of an investigation of scombroid-fish poisoning, made possible by quick diagnosis of an unusual disease, recognition of the important research questions, and action to collect the required information and specimens. The results of the investigation highlight the challenge to the food industry to prevent inadequate refrigeration, which promotes bacterial growth and subsequent food-borne illness. Cooking does not destroy the poison. Questions remain regarding the cause, treatment, and prevention of scombroid-fish poisoning, and the cause of absorption of large amounts of histamine remains to be identified. The disease is self-limiting, so the need for drug therapy as described in the article is not clear. The report shows the value of reporting food-borne disease and the importance of continuous refrigeration. It also demonstrates the importance of physician counseling of patients about proper food handling techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)