Scombroid Fish Poisoning: Treatment

Scombroid fishes are mackerel-like fish that include the albacore, yellowfin tuna, blue fin, mackerel, saury, needlefish, wahoo, skipjack and bonito. All the above fishes are included in scombroid fish family. Many non scombroid fishes can also produce scombroid poisoning and they include the dolphinfish, kahawai, sardine, black marlin, pilchard, anchovy, herring, amberjack, and salmon. Now non scombroid fishes are producing scombroid poisoning than scombroid fishes.

Histamine, histamine phosphate, and histamine hydrochloride are the active poisons in scombroid poisoning. All the above poisons are produced by decarboxylation of the amino acid L-histidine during decomposition in improperly preserved fish.

Treatment of scombroid fish poisoning:

The treatment is directed at the histamine and its related compounds. Both first generation and second generation anti histaminics are effective in the treatment of scombroid poisoning. First generation anti histaminics like pheniramine, cinnerazine and second generation anti histaminics like cetirizine, fexofenadine are equally effective in the treatment of scombroid poisoning. But the second generation anti histaminics are preferred because they are less sedative and they can be given as once a day dose and patient compliance is better.

If there is bronchospasm (constriction of bronchus) and it is severe, an inhaled bronchodilator like salbutamol is given and in extremely severe circumstances, injected epinephrine can be used. Glucocorticoids are not useful in scombroid poisoning induced bronchospasm.

If there is severe nausea and vomiting may be controlled with a specific antiemetic, like prochlorperazine. Headache of scombroid poisoning can be treated by simple analgesics. The persistent headache of scombroid poisoning if not controlled by simple analgesic may respond to cimetidine or a similar antihistamine. 

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