Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Scombroid (histamine) poisoning

Erin N Marcus, MD, MPH, FACP
Section Editors
Daniel F Danzl, MD
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH


Scombroid poisoning is a common seafood-associated disease throughout the world [1,2]. It may also occur after consumption of contaminated Swiss cheese. The most common findings consist of a rapid onset of flushing of the face and neck, erythematous and urticarial rash, diarrhea, and headache occurring soon after consumption of contaminated fish or cheese. Rarely, severe bronchospasm or cardiac effects may occur in patients with predisposing conditions, such as asthma or heart disease. Because of its clinical presentation, it is frequently misdiagnosed as seafood allergy. For most patients, management consists of treatment with H1 or H2 antihistamines. Patients with life-threatening airway edema, bronchospasm, or distributive shock warrant treatment as for anaphylaxis (table 1 and table 2) [3].

This topic will discuss the clinical manifestations, diagnosis, and management of scombroid (histamine) poisoning. Other microbial and marine foodborne diseases are discussed separately:

(See "Differential diagnosis of microbial foodborne disease".)

(See "Ciguatera fish poisoning".)

(See "Overview of shellfish and pufferfish poisoning".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Fleming LE, Washington G. Scombroid fish poisoning. Shoreland's Travel Medicine Monthly 1998; 2:2.
  2. Gould LH, Walsh KA, Vieira AR, et al. Surveillance for foodborne disease outbreaks - United States, 1998-2008. MMWR Surveill Summ 2013; 62:1.
  3. Stratta P, Badino G. Scombroid poisoning. CMAJ 2012; 184:674.
  4. Centers for Disease Control and Prevention (CDC). Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep 2007; 56:817.
  5. Wallace BJ, Guzewich JJ, Cambridge M, et al. Seafood-associated disease outbreaks in New York, 1980-1994. Am J Prev Med 1999; 17:48.
  6. Becker K, Southwick K, Reardon J, et al. Histamine poisoning associated with eating tuna burgers. JAMA 2001; 285:1327.
  7. Hungerford JM. Scombroid poisoning: a review. Toxicon 2010; 56:231.
  8. Clark RF, Williams SR, Nordt SP, Manoguerra AS. A review of selected seafood poisonings. Undersea Hyperb Med 1999; 26:175.
  9. New system for seafood safety. Environ Health Perspect 1998; 106:A475.
  10. Nordt SP, Pomeranz D. Scombroid poisoning from tilapia. Am J Emerg Med 2016; 34:339.e1.
  11. Taylor SL, Stratton JE, Nordlee JA. Histamine poisoning (scombroid fish poisoning): an allergy-like intoxication. J Toxicol Clin Toxicol 1989; 27:225.
  12. Lehane L, Olley J. Histamine fish poisoning revisited. Int J Food Microbiol 2000; 58:1.
  13. Outbreak alert. Closing the gaps in our federal food-safety net. Centers for Science in the Public Interest (CSPI), Washington, DC, 2008. Available at http://cspinet.org/new/pdf/outbreak_alert_2008_report_final.pdf (Accessed July 9, 2013).
  14. Pennotti R, Scallan E, Backer L, et al. Ciguatera and scombroid fish poisoning in the United States. Foodborne Pathog Dis 2013; 10:1059.
  15. Centers for Disease Control (CDC). Scombroid fish poisoning--Illinois, South Carolina. MMWR Morb Mortal Wkly Rep 1989; 38:140.
  16. Predy G, Honish L, Hohn W, Jones S. Was it something she ate? Case report and discussion of scombroid poisoning. CMAJ 2003; 168:587.
  17. Ferran M, Yébenes M. Flushing associated with scombroid fish poisoning. Dermatol Online J 2006; 12:15.
  18. Vickers J, Safai B. Images in clinical medicine. Scombroid poisoning. N Engl J Med 2013; 368:e31.
  19. Russell FE, Maretić Z. Scombroid poisoning: mini-review with case histories. Toxicon 1986; 24:967.
  20. Borysiewicz L, Krikler D. Scombrotoxic atrial flutter. Br Med J (Clin Res Ed) 1981; 282:1434.
  21. Feng C, Teuber S, Gershwin ME. Histamine (Scombroid) Fish Poisoning: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:64.
  22. Uragoda CG, Kottegoda SR. Adverse reactions to isoniazid on ingestion of fish with a high histamine content. Tubercle 1977; 58:83.
  23. Senanayake N, Vyravanathan S. Histamine reactions due to ingestion of tuna fish (Thunnus argentivittatus) in patients on anti-tuberculosis therapy. Toxicon 1981; 19:184.
  24. Kelso JM, Lin FL. Skin testing for scombroid poisoning. Ann Allergy Asthma Immunol 2009; 103:447.
  25. Bédry R, Gabinski C, Paty MC. Diagnosis of scombroid poisoning by measurement of plasma histamine. N Engl J Med 2000; 342:520.
  26. Dickinson G. Scombroid fish poisoning syndrome. Ann Emerg Med 1982; 11:487.
  27. Blakesley ML. Scombroid poisoning: prompt resolution of symptoms with cimetidine. Ann Emerg Med 1983; 12:104.
  28. Guss DA. Scombroid fish poisoning: successful treatment with cimetidine. Undersea Hyperb Med 1998; 25:123.