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U.S. Food & Drug Administration
Center for Food Safety & Applied Nutrition Foodborne Pathogenic Microorganisms and Natural Toxins Handbook |
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| 1. Name of the Organism: | Scombrotoxin |
| 2. Nature of Acute Disease: | Scombroid Poisoning (also called Histamine Poisoning)
Scombroid poisoning is caused by the ingestion of foods that contain high levels of histamine and possibly other vasoactive amines and compounds. Histamine and other amines are formed by the growth of certain bacteria and the subsequent action of their decarboxylase enzymes on histidine and other amino acids in food, either during the production of a product such as Swiss cheese or by spoilage of foods such as fishery products, particularly tuna or mahi mahi. However, any food that contains the appropriate amino acids and is subjected to certain bacterial contamination and growth may lead to scombroid poisoning when ingested. |
| 3. Nature of Disease: | Initial symptoms may include a tingling or burning sensation in the mouth, a rash on the upper body and a drop in blood pressure. Frequently, headaches and itching of the skin are encountered. The symptoms may progress to nausea, vomiting, and diarrhea and may require hospitalization, particularly in the case of elderly or impaired patients. |
| 4. Diagnosis of Human Illness: | Diagnosis of the illness is usually based on the patient's symptoms, time of onset, and the effect of treatment with antihistamine medication. The suspected food must be analyzed within a few hours for elevated levels of histamine to confirm a diagnosis. |
| 5. Associated Foods: | Fishery products that have been implicated in scombroid poisoning include the tunas (e.g., skipjack and yellowfin), mahi mahi, bluefish, sardines, mackerel, amberjack, and abalone. Many other products also have caused the toxic effects. The primary cheese involved in intoxications has been Swiss cheese. The toxin forms in a food when certain bacteria are present and time and temperature permit their growth. Distribution of the toxin within an individual fish fillet or between cans in a case lot can be uneven, with some sections of a product causing illnesses and others not. Neither cooking, canning, or freezing reduces the toxic effect. Common sensory examination by the consumer cannot ensure the absence or presence of the toxin. Chemical testing is the only reliable test for evaluation of a product. |
| 6. Relative Frequency of Disease: | Scombroid poisoning remains one of the most common forms of fish poisoning in the United States. Even so, incidents of poisoning often go unreported because of the lack of required reporting, a lack of information by some medical personnel, and confusion with the symptoms of other illnesses. Difficulties with underreporting are a worldwide problem. In the United States from 1968 to 1980, 103 incidents of intoxication involving 827 people were reported. For the same period in Japan, where the quality of fish is a national priority, 42 incidents involving 4,122 people were recorded. Since 1978, 2 actions by FDA have reduced the frequency of intoxications caused by specific products. A defect action level for histamine in canned tuna resulted in increased industry quality control. Secondly, blocklisting of mahi mahi reduced the level of fish imported to the United States. |
| 7. Course of Disease and Complications: | The onset of intoxication symptoms is rapid, ranging from immediate to 30 minutes. The duration of the illness is usually 3 hours, but may last several days. |
| 8. Target Populations: | All humans are susceptible to scombroid poisoning; however, the symptoms can be severe for the elderly and for those taking medications such as isoniazid. Because of the worldwide network for harvesting, processing, and distributing fishery products, the impact of the problem is not limited to specific geographical areas of the United States or consumption pattern. These foods are sold for use in homes, schools, hospitals, and restaurants as fresh, frozen, or processed products. |
| 9. Food Analysis: | An official method was developed at FDA to determine histamine, using a simple alcoholic extraction and quantitation by fluorescence spectroscopy. There are other untested procedures in the literature. |
| 10. Selected Outbreaks: | Literature references can be found at the links below. |
| MMWR 38(9):1989 | Scombroid fish poisoning is an acute syndrome resulting from consumption of fish containing high levels of histamine. This report summarizes investigations of two outbreaks of scombroid fish poisoning in Illinois and South Carolina in 1988. |
| MMWR 37(29):1988 | In July 1987, state and local public health officials in New Mexico investigated two cases of scombroid fish poisoning (histamine poisoning) in persons living in Albuquerque. A husband and wife had become ill within 45 minutes after eating dinner. Their symptoms included nausea, vomiting, diarrhea, headache, fever, flushing, and rapid pulse rate. An investigation by the Albuquerque Environmental Health Department found that the couple had shared a meal of grilled mahi mahi, pasta, salad, water, and wine. Their dog had eaten some of the fish and had vomited. Both of the patients had been treated with Benadryl, activated charcoal, and ipecac in a hospital emergency room. Their symptoms resolved within 36 hours of onset of illness. |
| MMWR 35(16):1986 | Between December 31, 1985, and January 4, 1986, three restaurants in Alabama and Tennessee received complaints of illness from nine customers and one employee who ate Pacific amberjack fish (also called yellowtail or kahala). One restaurant cook, who did not eat the fish, reported a transient red rash on the hands shortly after handling the fish. Ill persons reported no other menu items in common. The fish meals were prepared by grilling or frying. Three people sought medical evaluation. One had diastolic hypotension, and one had bronchospasm. All three were diagnosed as having food or fish allergy and were treated with an antihistamine. The symptoms of scombroid fish poisoning resemble those of a histamine reaction. Scombroid poisoning is a response to toxic by-products--not an allergic reaction to fish. |
| Several large outbreaks of scombroid poisoning have been reported. In 1970, some 40 children in a school lunch program became ill from imported canned tuna. In 1973, more than 200 consumers across the United States were affected by domestic canned tuna. In 1979-1980 more than 200 individuals became ill after consuming imported frozen mahi mahi. Symptoms varied with each incident. In the 1973 situation, of the interviewed patients, 86% experienced nausea, 55% diarrhea, 44% headaches and 32% rashes. | |
| Other incidents of intoxication have resulted from the consumption of canned abalone-like products, canned anchovies, and fresh and frozen amberjack, bluefish sole, and scallops. In particular, shipments of unfrozen fish packed in refrigerated containers have posed a significant problem because of inadequate temperature control. | |
| Morbidity and Mortality Weekly Reports | For more information on recent outbreaks see the CDC. |
| 11. Education and Background Resources: | Literature references can be found at the links below. |
| Loci index for genome | Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence. |
| 12. Molecular Structural Data: | This structure was created by Fred Fry, Ph.D, CFSAN. |
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Scombroid Toxin |
mow@cfsan.fda.gov
January 1992 with periodic updates