By Gary M. White, MD

Eating spoiled fish from the Scromboid family (e.g. tuna, bonito, mackerel, skipjack) may cause scromboid fish poisoning. When such a fish is stored improperly, decarboxylation of histadine to histamine may occur, leading to histamine poisoning that may mimic an IgE mediated allergic reaction.


Nausea, vomiting, diarrhea, hives, itching, rash and hypotension within minutes to hours of eating the fish is typical. The symptoms may last up to 24 hours. The diagnosis is made by measuring the tissue histamine concentration in the fish.


No treatment is needed for mild disease. Moderate or severe symptoms may be treated with antihistamines.


Ninety minutes after eating a mahi-mahi sandwich at a “gourmet” hamburger restaurant, a 52-year-old man developed a diffuse erythematous non-pruritic urticarial rash, without wheal, over his trunk, face, and proximal arms and legs with scattered areas of sparing over his abdomen and back. J Med Toxicol. 2015 Sep; 11(3): 377–378.


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