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termed scombroid poisoning (Scombridae family of fish is most commonly associated with this toxicity). Treatment with maximal doses of histamine blockers, especially H1 blockers, is usually sufficient to control the symptoms. Because this is not an allergic reaction, administration of epinephrine is not necessary unless hypotension or airway obstruction is severe. (See Edlow JA: The Deadly Dinner Party: And Other Medical Detective Stories. Yale University Press, 2009.) These patients demonstrate typical symptoms and signs caused by histamine. Fortunately, neither patient in this episode of food poisoning had significant laryngeal edema or bronchospasm. Certain types of fish, if improperly preserved, contain large quantities of histamine, due to the conversion—by bacteria contaminating the muscle tissue—of histidine to histamine. If consumed in suf-ficient amount, enough histamine can be absorbed to cause the clinical picture described. This syndrome is
Ian A. Reid, PhD