Article tiré de Emerg Med Clinics of North Am. août 2007 Scombroid Background Scombroid poisoning occurs after ingestion of fish that has accumulated scombrotoxin secondary to spoilage. The fish associated with this toxicity are dark fleshed, containing large amounts of the amino acid histidine. Scombroid food poisoning develops when an individual ingests improperly refrigerated fish in which bacteria have converted histidine into histamine and histaminelike substances. Pure histamine itself is not toxic when taken orally. Therefore, scombroid is not solely caused by excess histamine ingestion. There are other factors involved in toxicity, including substances that facilitate histamine absorption and urocanic acid that acts as a mast cell degranulator adding to the histamine-related symptoms. Fish commonly implicated include those in the Scombridae and Scomberesocidae families, such as tuna, mackerel, and bonito. Nonscombroid fish, such as mahi-mahi, bluefish, anchovies, sardines, swordfish, and escolar, have also caused this syndrome. Clinical presentation Patients who ingest scombroid present with signs and symptoms of a histamine reaction: flushing, erythematous or urticarial rash, headache, dizziness, crampy abdominal pain, nausea, vomiting, diarrhea, shortness of breath, and wheezing. In severe cases it can lead to hypotension and even hemodynamic collapse. The ingested causative fish usually does not smell or taste spoiled, but the victims often report an unusual peppery or metallic taste. Symptoms begin within an hour and usually last less than 12 hours. Scombroid poisoning may be worse in patients taking isoniazid. Isoniazid acts as a histaminase inhibitor. Patients taking isoniazid may have more severe or prolonged reaction to scombroid poisoning. Diagnosis The diagnosis is accomplished by observing the clinical syndrome of scombroid toxicity with a history of eating causative fish. Although the treatment of scombroid is similar to that of an acute type I allergic reaction, it is important to not label these as allergic reactions. These patients do not have seafood allergies and should not be told to avoid seafood. Evidence suggests that victims of scombroid poisoning have elevated plasma and urinary histamine levels . This finding may aid in confirming cases but is not useful in guiding emergency clinical decisions. The fish may also be tested to aid in confirming the diagnosis, but this can be misleading because histamine levels can vary greatly even within the same cut of fish. Management The cornerstone of treatment is with antihistamines. Intravenous H1 and H2 blockers (ie, diphenhydramine and cimetidine, respectively) should be administered. Bronchodilators (ie, albuterol) can be helpful if the patient experiences bronchospasm. Severe cases, with hypotension and respiratory distress, require aggressive treatment with intravenous fluids, airway control, and possibly epinephrine. Scombroid poisoning is a self-limited illness; symptoms typically resolve within 12 hours.
From: [EMAIL PROTECTED]: [EMAIL PROTECTED]: URG-L: Re: URG-L: Beau cas mystère!Date: Fri, 22 Feb 2008 18:43:18 +0100 syndrome histaminique le marlin fait il partie de la famille des scombridés ? 13 ans et deja une jeune femme, troublante adolescente ----- Original Message ----- From: Martin Loranger To: [EMAIL PROTECTED] Sent: Friday, February 22, 2008 6:22 PM Subject: URG-L: Beau cas mystère! Jeune femme de 13 ans, qui se présente après avoir mangé du marlin bleu, et qui aurait eu des rougeurs sur le corps (urticaire?) et une sensation de prurit dans la gorge et de sensation d'oppression thoracique, quelques minutes après le début d'ingestion. Aucun antécédent pertinent. Aucune allergie connue ni chez elle ni dans la famille. Je retourne voir la pte, vue par une excellente résidente, afin de discuter de l'observation ou non avec la mère. Je note que la pte mange du poisson très fréquemment, et que c'est la première fois qu'une telle réaction a lieu, même si elle a déjà mangé du marlin bleu auparavant. Je demande à la mère si au moins le poisson était bon: "C'est drôle parce que tout le monde a eu une drôle de sensation en bouche, comme si c'était trop épicé...". D'ailleurs, la mère a eu elle aussi des rougeurs au visage et sur les bras, ayant duré moins de temps... La mère m'assure ne pas avoir trop épicé le poisson... La jeune est maintenant ASx, 4 heures après l'ingestion. Signes vitaux normaux actuellement et à l'arrivée, quelques heures plus tôt! La mère lui a donné 50 mg de Bénadryl à la maison. Votre Dx? Martin LorangerUrgence Charles LeMoyne _________________________________________________________________
