Gingras Véronique, Marois Louis
Division of Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Canada.
Division of Specialized Medicine, Faculty of Medicine, Université Laval, Québec, Canada.
Int J Emerg Med. 2025 Jul 3;18(1):122. doi: 10.1186/s12245-025-00930-3.
Scombroid syndrome, a pseudo-allergic reaction caused by histamine-contaminated fish, is often mistaken for type I hypersensitivity reactions due to overlapping clinical presentations. Unlike IgE-mediated anaphylaxis, Scombroid syndrome results from histamine production by bacterial histidine decarboxylase in improperly preserved fish. It accounts for 5% of U.S. food poisoning cases and manifests within 30 min to two hours post-ingestion.
Symptoms include rash, pruritus, vomiting, and tongue swelling, as exemplified by a case of a 30-year-old woman misdiagnosed with anaphylaxis after consuming salmon. However, typically mild and self-limiting, severe cases may involve bronchospasm and arrhythmias. Diagnosis hinges on patient history, symptom onset, and absence of food allergy markers, such as elevated tryptase. Management includes antihistamines and supportive care; epinephrine and corticosteroids are reserved for severe reactions.
Clinicians must distinguish Scombroid syndrome from anaphylaxis to ensure accurate treatment, emphasizing proper fish preservation to prevent outbreaks.
鲭鱼中毒综合征是一种由组胺污染的鱼类引起的类过敏反应，由于临床表现重叠，常被误诊为I型超敏反应。与IgE介导的过敏反应不同，鲭鱼中毒综合征是由保存不当的鱼类中细菌组氨酸脱羧酶产生组胺所致。它占美国食物中毒病例的5%，在摄入后30分钟至两小时内出现症状。
症状包括皮疹、瘙痒、呕吐和舌头肿胀，例如一名30岁女性食用三文鱼后被误诊为过敏反应的病例。然而，通常症状较轻且具有自限性，严重病例可能涉及支气管痉挛和心律失常。诊断取决于患者病史、症状发作情况以及是否存在食物过敏标志物，如升高的类胰蛋白酶。治疗包括使用抗组胺药和支持性护理；严重反应时才使用肾上腺素和皮质类固醇。
临床医生必须将鲭鱼中毒综合征与过敏反应区分开来，以确保准确治疗，强调正确保存鱼类以预防疫情爆发。
