Scombroid fish poisoning: latest evidences of a still unknown disease

Foodborne diseases are common but often undernotified causes of morbidity in the United States and Italy, and fish foods are often involved in these diseases. The scombroid fish poisoning is a chemical poisoning characterized by symptoms that appear from 10 minutes to 2 hours after the consumption of scombroid and not scombroid fish. The scombroid fishes naturally contain high levels of histidine which is converted to histamine as a result of the action of the histidine decarboxylase contained in bacteria, which grow and multiply if there are no appropriate conditions to control their growth. Symptoms are characterized by rashes on the face, neck and upper chest, flushing, sweating, nausea, vomiting, diarrhea, abdominal cramps, headache, dizziness, palpitations, oral burning sensation, metallic taste and hypotension, which usually resolve within 24 hours. It was recently reported in literature (2015), a case of Kounis syndrome with coronary vasospasm precipitated by scombroid fish poisoning. The rapid cooling of the fish, and the strict maintenance of the cold chain until consumption are essential to prevent the degradation of the fish, the proliferation of bacteria, the histidine decarboxylase activation, the conversion of histidine to histamine and the development of an anaphylactoid reaction resulting in ingestion.