Ingestion of histamine in food can result in clinical findings associated with an allergic reaction. In scombroid the vehicle is poorly preserved fish. In some cases ingestion of insects has been implicated.
Proposed mechanism: histidine is decarboxylated to histamine by bacteria
Conditions:
(1) outbreak of allergic-like reactions affecting a group of people (not isolated individuals)
(2) onset following ingestion of insects
(3) not affected by heating the food (histamine is heat-stable)
(4) presence of histamine in analysis of implicated food
(5) exclusion of other conditions
Clinical features:
(1) flushing
(2) pruritis
(3) urticarial rash
(4) headache
(5) nausea and vomiting
(6) diarrhea
(7) dyspnea
(8) bronchospasm
Differential diagnosis:
(1) insect allergy
(2) other allergic reaction
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