Scombroid fish poisoning (SFP) is a form of histamine food poisoning caused by the ingestion of improperly stored
fish. The term “scombroid” derives from the family name of the fish family first implicated, such as tuna and mackerel.
On the other hand, non-scombroid fish species, such as sardine and herring, can also cause histamine poisoning.
The histamine is converted from histidine by a bacterial enzyme in the causative fish. Because the symptoms of
SFP can easily be confused with food allergies, it is believed to have been significantly under-reported. In 2016, an
outbreak of SFP occurred among primary school students who had eaten yellowtail steak in Korea. The most common
findings consisted of a rapid onset of flushing of the face and trunk, erythematous and urticarial rash, diarrhea,
and headache occurring soon after consuming the spoiled fish. Usually, the course is self-limiting and antihistamines
can be used successfully to relieve symptoms, but several life-threatening SFP cases have been reported.
Clinical toxicologists should be familiar with SFP and have competency to make a differential diagnosis between
fish allergy and histamine poisoning. SFP is a histamine-induced reaction caused by the ingestion of histamine-contaminated
fish, whereas a fish allergy is an IgE-mediated reaction. This review discusses the epidemiology, pathophysiology,
diagnosis, treatment, and preventive measures of SFP.