Practical Dermatology
Scombroid Poisoning: A Practical Approach
Escombroidosis: abordaje práctico
O. Guergué-Díaz de Cerio
, A. Barrutia-Borque, J. Gardeazabal-García
Corresponding author
Servicio de Dermatología, Hospital Universitario Cruces, Vizcaya, Spain
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Parte <span class="elsevierStyleSmallCaps">I</span>: introducción, el monje resucitado «lac virginis», el ergotismo y la lepra" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 996 "Ancho" => 900 "Tamanyo" => 197309 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Persons with ergotism, or St. Martial's fire, in Cantiga 91. Note the loss of distal extremities.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">© by Patrimonio Nacional.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Romaní, X. Sierra, A. Casson" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." 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Guergué-Díaz de Cerio, A. Barrutia-Borque, J. Gardeazabal-García" "autores" => array:3 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Guergué-Díaz de Cerio" "email" => array:2 [ 0 => "olaneguergue06051988@gmail.com" 1 => "olane.guerguediazdecerio@osakidetza.eus" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Barrutia-Borque" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Gardeazabal-García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Cruces, Vizcaya, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Escombroidosis: abordaje práctico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 861 "Ancho" => 1600 "Tamanyo" => 240117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A and B, Generalized erythematous rash mainly affecting the face (not shown in the image) and the trunk of the patient.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> C, Detailed view of the upper thorax. Note the absence of whealing.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reproduced with permission from Jantschitsch et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Scombroid poisoning, also known as histamine fish poisoning, is a histamine toxicity syndrome first described in the United Kingdom in 1799.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> It is a common cause of food poisoning worldwide and is triggered by the ingestion of contaminated oily fish. Although the true incidence of scombroid poisoning is unknown in Spain, this country would be considered a risk area because of its high levels of fish consumption. The condition typically presents with skin manifestations in the form of flushing and/or a urticarial rash.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with scombroid poisoning typically seek medical attention for their symptoms in primary care centers or emergency departments, although because the condition is mild and self-limiting, it is probably safe to assume that a considerable proportion of patients do not visit a doctor. Accordingly, and also because scombroid poisoning is frequently confused with a food allergy, many cases are not reported and it is probably underdiagnosed.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> The aim of this article is to provide a practical overview of scombroid poisoning and to guide dermatologists in its diagnosis and treatment, as it is not unusual for us to be called on to evaluate the skin lesions seen with this syndrome.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Scombroid poisoning exists around the world. Its incidence is unknown, and reported rates vary enormously from one area to the next depending on fish consumption habits. An estimated annual incidence of between 2 and 5 cases per 1 million inhabitants has been reported for Denmark, New Zealand, France, and Finland, while rates for Hawaii have been as high as 31 cases per 1 million inhabitants a year.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> The largest numbers of cases have been reported in Japan, the United Kingdom, the United States, and Australia.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> In the United States and Europe, scombroid poisoning accounts for up to 40% of all food poisoning outbreaks.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Scombroid poisoning typically affects groups of diners who have eaten contaminated oily fish. It has traditionally been linked to the consumption of fish from the Scombroidae and Scomberesocidae family, such as tuna fish (responsible for over 80% of cases), mackerel, and bonito. Cases, however, have also been linked to other types of fish, such as anchovies, greater amberjack fish, swordfish, herring, sardines, salmon, trout, and even dolphin and Swiss cheese.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pathogenesis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Scombroid, or histamine fish, poisoning, is caused by the ingestion of poorly conserved fish, i.e., fish that has generally been stored at a temperature of above 4<span class="elsevierStyleHsp" style=""></span>°C. These conditions favor the growth of different bacteria, triggering the conversion of histidine (present in the meat of oily fish) to histamine by bacterial enzymes,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3,4</span></a> namely histidine decarboxylase. The conversion takes place in a matter of hours, such that fish stored at 20<span class="elsevierStyleHsp" style=""></span>°C can accumulate toxic levels of histamine in just 2<span class="elsevierStyleHsp" style=""></span>hours. Levels of over 50<span class="elsevierStyleHsp" style=""></span>mg of histamine per 100<span class="elsevierStyleHsp" style=""></span>g of fish are necessary to trigger the clinical manifestations of scombroid poisoning.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> (Histamine levels in fresh fish are less than 0.01<span class="elsevierStyleHsp" style=""></span>mg/100<span class="elsevierStyleHsp" style=""></span> g.) The most commonly implicated bacterial agent is <span class="elsevierStyleItalic">Escherichia coli</span>, although there have been cases attributed to bacteria from the species <span class="elsevierStyleItalic">Vibrio</span>, <span class="elsevierStyleItalic">Proteus</span>, <span class="elsevierStyleItalic">Serratia</span>, <span class="elsevierStyleItalic">Enterobacter</span>, <span class="elsevierStyleItalic">Klebsiella</span>, <span class="elsevierStyleItalic">Clostridium</span>, <span class="elsevierStyleItalic">Salmonella</span>, and <span class="elsevierStyleItalic">Shigella</span>. Histamine poisoning generally affects fresh fish rather than canned fish,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> as the latter is typically subject to more quality controls and cans generally contain different specimens of fish, meaning that the toxic effect of a single contaminated specimen would be minimized. Although the canning process can destroy the bacteria, it cannot destroy histamine that has already formed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical Presentation</span><p id="par0030" class="elsevierStylePara elsevierViewall">The clinical manifestations of scombroid poisoning appear within minutes to hours of eating contaminated fish and are the result of histamine poisoning. Histamine is an endogenous amine with numerous biological effects,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> including vasodilation, an immediate allergic response following activation of H<span class="elsevierStyleInf">1</span> receptors, and neurotransmission due to the activation of H<span class="elsevierStyleInf">3</span> receptors. The amount of histamine required to produce manifestations varies from one person to the next. Scombroid poisoning symptoms tend to be mild and typically start with a burning or tingling sensation on the tongue, accompanied or not by a peppery and/or metallic taste. This is gradually followed by flushing in the head and neck area, with a considerable burning sensation, and a downward-spreading erythematous urticarial rash on the face and upper trunk<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Other common symptoms are a burning sensation, pruritus, and swelling around the mouth. Gastrointestinal symptoms are also common and include stomach cramps, nausea, vomiting, and diarrhea. A throbbing headache and palpitations are other hallmark symptoms. Because of the similarity with allergic reaction symptoms, scombroid poisoning is frequently mistaken for immunoglobulin E (IgE)–mediated fish allergy. Although rare, there have been reports of hypotension with distributive shock, bronchospasm, respiratory distress, and cardiac arrhythmias; these complications tend to occur in patients with an underlying condition (e.g., asthma or heart disease),<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8–10</span></a> explaining why some authors have described scombroid poisoning as a dermatologic emergency.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Symptoms typically disappear within 12 to 48<span class="elsevierStyleHsp" style=""></span>hours without treatment and leave no short-term or long-term sequelae. Patients under treatment with isoniazid or monoamine oxidase inhibitors (MAOIs) are more vulnerable to histamine fish poisoning<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> and develop more severe and lasting symptoms, as these drugs inhibit the metabolism of histamine. Patients under treatment with antihistamines, by contrast, are somewhat protected against scombroid poisoning as these block the effect of histamine.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagnosis</span><p id="par0040" class="elsevierStylePara elsevierViewall">There are no specific diagnostic tests for scombroid poisoning in humans. The condition is generally diagnosed on clinical grounds and a recent history of fish ingestion.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> A thorough history is thus very important for the correct diagnosis of scombroid poisoning (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The following findings can also help to raise suspicion:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Onset of symptoms within 1 hour of eating scombroid fish</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Histamine-mediated symptoms, such as flushing, rash, headache, diarrhea, etc.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Epidemiological data: similar symptoms in other diners</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Rapid resolution of symptoms following the administration of antihistamines</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Once scombroid poisoning is suspected, a definitive diagnosis can be established by measuring histamine levels in the fish implicated in the episode. Levels of over 50<span class="elsevierStyleHsp" style=""></span>mg per 100<span class="elsevierStyleHsp" style=""></span>g of fish are considered toxic.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> In Europe, histamine levels must not exceed 10<span class="elsevierStyleHsp" style=""></span>mg per 100<span class="elsevierStyleHsp" style=""></span>g. Levels are determined by sending samples of the suspect fish to the laboratory, accompanied, where appropriate, by other products from the same lot. It is important to ensure that the samples are shipped in a frozen state to prevent the formation of histamine during shipment. Furthermore, because histamine levels can vary enormously from one part of the fish to another, different sections should be sent.</p><p id="par0070" class="elsevierStylePara elsevierViewall">It is also useful to measure plasma histamine levels in the patient<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>; a 2- to 4-fold increase above normal is suggestive of poisoning. This test must be performed within 24<span class="elsevierStyleHsp" style=""></span>hours, as levels return to normal after this time. High plasma histamine levels within the first 4<span class="elsevierStyleHsp" style=""></span>hours have been proposed as a specific finding for scombroid poisoning.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Differential Diagnosis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The following conditions should be contemplated in the differential diagnosis<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a>:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><p id="par0080" class="elsevierStylePara elsevierViewall">Allergic reaction to fish. This is the most common condition with which scombroid poisoning is confused. De novo fish allergy is rare in adults, with a prevalence of just 0.6%.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> However, the absence of known allergies, similar symptoms in other diners, and, where possible, the detection of toxic histamine levels in fish, all help to establish a diagnosis of scombroid poisoning. If the suspicion of an allergic reaction persists, specific IgE levels should be measured or the patient referred to an allergologist.</p></li><li class="elsevierStyleListItem" id="lsti0030"><p id="par0085" class="elsevierStylePara elsevierViewall">Acute myocardial infarction. This condition is distinguishable from scombroid poisoning in that its main manifestation is intense, oppressive chest pain, accompanied by symptoms such as profuse sweating, dizziness, nausea, vomiting, etc. Serial electrocardiograms and normal cardiac markers help to rule out infarction.</p></li><li class="elsevierStyleListItem" id="lsti0035"><p id="par0090" class="elsevierStylePara elsevierViewall">Staphylococcal food poisoning. Unlike scombroid food poisoning, staphylococcal food poisoning is generally characterized by fever and does not cause flushing or rash.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Treatment</span><p id="par0095" class="elsevierStylePara elsevierViewall">Given the benign nature of scombroid poisoning and its tendency to spontaneously resolve, many patients do not require treatment. In the case of mild symptoms (flushing, burning, rash, or swelling around the mouth), the only effective treatment is the prompt administration of oral antihistamines for 1 to 2 days.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> H<span class="elsevierStyleInf">1</span> antihistamines, including cetirizine, are preferable as they are nonsedating. They can be combined with an H<span class="elsevierStyleInf">2</span> antihistamine, such as cimetidine, famotidine, or ranitidine.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> With this treatment, symptoms should resolve within 6 to 8<span class="elsevierStyleHsp" style=""></span>hours. It is unnecessary to prolong treatment for longer than 2 days, as this is the time it takes for the toxin to be completely absorbed or eliminated and consequently for the clinical manifestations to disappear.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Intravenous antihistamines can be administered to patients with very bothersome symptoms or patients who do not tolerate oral antihistamines. The drugs of choice in such cases are diphenhydramine, famotidine, and ranitidine.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients who experience hypertension or dehydration should be administered fluids, and vomiting can be treated with intravenous promethazine. The use of epinephrine or other vasoconstrictors should be considered in patients with severe symptoms, although these situations are extremely rare (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Corticosteroids<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> and epinephrine are not indicated in mild cases, as their action is independent of the pathogenesis of scombroid poisoning. In other words, they do not reduce histamine levels and as such are ineffective.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The prophylactic use of antihistamines is not justified either,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> although it could be indicated in a patient about to eat fish who is being treated with isoniazid and/or MAOIs and has had a prior episode of scombroid poisoning.</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is important to educate patients on the origin of the condition and remind them that it is not a fish allergy and they can therefore eat fish without fear of a reaction.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Prognosis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Scombroid poisoning is generally a benign, self-limiting condition. However, because there have been reports of distributive shock, bronchospasm, and cardiac arrhythmias, early diagnosis and treatment is important. There has just been 1 reported death due to scombroid poisoning worldwide.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Prevention</span><p id="par0130" class="elsevierStylePara elsevierViewall">The most important consideration is that scombroid poisoning can be prevented by rapidly refrigerating fish for consumption. Fish should be ideally be stored at a temperature of 0<span class="elsevierStyleHsp" style=""></span>°C or less to prevent both the growth of bacteria and the activation of histidine decarboxylase. It is important to recall that while cooking or freezing contaminated fish can destroy the bacteria, it will not destroy the toxin, which is stable in heat and cold.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Finally, outbreaks of scombroid poisoning should always be reported to the health department to prevent other cases.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">Scombroid poisoning is a common cause of fish poisoning and is very probably underdiagnosed. It typically presents with cutaneous lesions and is treated with oral antihistamines for 1 to 2 days. Complications are rare. Prevention is unquestionably the best “cure”, as once histamine has formed, reactions cannot be prevented by cooking, freezing, or canning. Familiarity with this condition among dermatologists will help to prevent confusion with allergic reactions to fish. As scombroid poisoning presents with skin lesions, it is likely that at some point in our career, we will be called on by the emergency department to evaluate a case of scombroid poisoning.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres828133" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec824362" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres828132" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec824363" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Pathogenesis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Presentation" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Differential Diagnosis" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Treatment" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Prognosis" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Prevention" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of Interest" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-11-27" "fechaAceptado" => "2016-02-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec824362" "palabras" => array:4 [ 0 => "Histamine poisoning" 1 => "Scombroid poisoning" 2 => "Fish" 3 => "Food poisoning" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec824363" "palabras" => array:4 [ 0 => "Intoxicación histamínica" 1 => "Escombroidosis" 2 => "Pescado" 3 => "Toxiinfección alimentaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scombroid poisoning is a common cause of food poisoning worldwide. It is caused by ingestion of oily fish contaminated with bacteria that trigger the formation of high concentrations of histamine. Scombroid poisoning manifests mainly as a skin complaint (flushing that spreads downward and/or an erythematous urticarial rash affecting the face and upper trunk). Although the clinical course is usually self-limiting and benign, vascular compromise, bronchospasm, and arrhythmias have been described. It is important to establish a differential diagnosis that includes conditions such as fish allergy. Oral antihistamines are the mainstay of treatment. Scombroid poisoning is best prevented by refrigerating fish properly. The practical review of scombroid poisoning provided here is intended for dermatologists.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La escombroidosis es una causa frecuente de intoxicación alimentaria a nivel mundial que se debe a la ingesta de pescado azul contaminado con bacterias que inducen la formación de grandes cantidades de histamina. Clínicamente se manifiesta sobre todo a nivel cutáneo, en forma de <span class="elsevierStyleItalic">flushing</span> descendente y/o <span class="elsevierStyleItalic">rash</span> eritemato-urticariforme facial y en el tronco superior. Aunque habitualmente tiene un curso autolimitado y benigno, pueden existir casos de compromiso vascular, broncoespasmo y arritmias. Es importante hacer un correcto diagnóstico diferencial, entre otros con la alergia al pescado. El tratamiento se basa en la administración de antihistamínicos orales. Lo más importante es su prevención mediante una correcta refrigeración del pescado. Este trabajo es una revisión práctica de la escombroidosis orientada para su uso por el dermatólogo.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guergué-Díaz de Cerio O, Barrutia-Borque A, Gardeazabal-García J. Escombroidosis: abordaje práctico. Actas Dermosifiliogr. 2016;107:567–571.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 861 "Ancho" => 1600 "Tamanyo" => 240117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A and B, Generalized erythematous rash mainly affecting the face (not shown in the image) and the trunk of the patient.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> C, Detailed view of the upper thorax. Note the absence of whealing.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reproduced with permission from Jantschitsch et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1663 "Ancho" => 2242 "Tamanyo" => 361310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Algorithm for managing a suspected case of scombroid poisoning.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type of fish ingested? Cooked/raw? Smell and appearance? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Any other food eaten before the onset of symptoms? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First episode? Have there been similar episodes? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">How long between ingestion of the fish and the appearance of symptoms? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Comorbidities? Particularly asthma or other chest conditions and heart disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Usual treatment? Particularly antihistamines, isoniazid or monoamine oxidase inhibitors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Where did it happen (home, restaurant, etc.)? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Any other diners affected? \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393366.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Questions to Ask When Faced With a Suspected Case of Scombroid Poisoning.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scombrotoxic fish poisoning: Features of the first 50 incidents to be reported in Britain (1976-9)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 37 | 7 | 44 |
| 2024 October | 232 | 54 | 286 |
| 2024 September | 264 | 36 | 300 |
| 2024 August | 332 | 60 | 392 |
| 2024 July | 366 | 46 | 412 |
| 2024 June | 284 | 40 | 324 |
| 2024 May | 370 | 57 | 427 |
| 2024 April | 226 | 54 | 280 |
| 2024 March | 287 | 40 | 327 |
| 2024 February | 321 | 33 | 354 |
| 2024 January | 358 | 44 | 402 |
| 2023 December | 380 | 35 | 415 |
| 2023 November | 387 | 49 | 436 |
| 2023 October | 322 | 31 | 353 |
| 2023 September | 217 | 43 | 260 |
| 2023 August | 136 | 19 | 155 |
| 2023 July | 191 | 40 | 231 |
| 2023 June | 177 | 50 | 227 |
| 2023 May | 126 | 84 | 210 |
| 2023 April | 112 | 184 | 296 |
| 2023 March | 104 | 31 | 135 |
| 2023 February | 102 | 41 | 143 |
| 2023 January | 82 | 41 | 123 |
| 2022 December | 98 | 65 | 163 |
| 2022 November | 57 | 55 | 112 |
| 2022 October | 46 | 42 | 88 |
| 2022 September | 62 | 54 | 116 |
| 2022 August | 63 | 53 | 116 |
| 2022 July | 50 | 66 | 116 |
| 2022 June | 69 | 54 | 123 |
| 2022 May | 153 | 78 | 231 |
| 2022 April | 162 | 65 | 227 |
| 2022 March | 186 | 64 | 250 |
| 2022 February | 176 | 64 | 240 |
| 2022 January | 200 | 45 | 245 |
| 2021 December | 109 | 59 | 168 |
| 2021 November | 110 | 43 | 153 |
| 2021 October | 111 | 82 | 193 |
| 2021 September | 83 | 64 | 147 |
| 2021 August | 78 | 45 | 123 |
| 2021 July | 59 | 42 | 101 |
| 2021 June | 101 | 53 | 154 |
| 2021 May | 104 | 53 | 157 |
| 2021 April | 277 | 129 | 406 |
| 2021 March | 153 | 34 | 187 |
| 2021 February | 115 | 51 | 166 |
| 2021 January | 104 | 40 | 144 |
| 2020 December | 77 | 34 | 111 |
| 2020 November | 53 | 22 | 75 |
| 2020 October | 37 | 24 | 61 |
| 2020 September | 59 | 19 | 78 |
| 2020 August | 30 | 24 | 54 |
| 2020 July | 33 | 18 | 51 |
| 2020 June | 52 | 40 | 92 |
| 2020 May | 36 | 19 | 55 |
| 2020 April | 31 | 18 | 49 |
| 2020 March | 36 | 24 | 60 |
| 2020 February | 4 | 0 | 4 |
| 2019 December | 2 | 0 | 2 |
| 2019 September | 6 | 0 | 6 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 18 | 1 | 19 |
| 2019 March | 4 | 3 | 7 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 4 | 0 | 4 |
| 2018 December | 6 | 0 | 6 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 39 | 10 | 49 |
| 2018 January | 49 | 26 | 75 |
| 2017 December | 63 | 15 | 78 |
| 2017 November | 44 | 12 | 56 |
| 2017 October | 63 | 12 | 75 |
| 2017 September | 65 | 15 | 80 |
| 2017 August | 59 | 28 | 87 |
| 2017 July | 35 | 22 | 57 |
| 2017 June | 42 | 15 | 57 |
| 2017 May | 53 | 30 | 83 |
| 2017 April | 34 | 31 | 65 |
| 2017 March | 22 | 26 | 48 |
| 2017 February | 69 | 26 | 95 |
| 2017 January | 28 | 15 | 43 |
| 2016 December | 44 | 37 | 81 |
| 2016 November | 34 | 23 | 57 |
| 2016 October | 35 | 30 | 65 |
| 2016 September | 1 | 0 | 1 |
| 2016 July | 3 | 5 | 8 |
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