Histamine, histamine intoxication and intolerance.

Excessive accumulation of histamine in the body leads to miscellaneous symptoms mediated by its bond to corresponding receptors (H1-H4). Increased concentration of histamine in blood can occur in healthy individuals after ingestion of foods with high contents of histamine, leading to histamine intoxication. In individuals with histamine intolerance (HIT) ingestion of food with normal contents of histamine causes histamine-mediated symptoms. HIT is a pathological process, in which the enzymatic activity of histamine-degrading enzymes is decreased or inhibited and they are insufficient to inactivate histamine from food and to prevent its passage to blood-stream. Diagnosis of HIT is difficult. Multi-faced, non-specific clinical symptoms provoked by certain kinds of foods, beverages and drugs are often attributed to different diseases, such as allergy and food intolerance, mastocytosis, psychosomatic diseases, anorexia nervosa or adverse drug reactions. Correct diagnosis of HIT followed by therapy based on histamine-free diet and supplementation of diamine oxidase can improve patient's quality of life.

A case of histamine fish poisoning in a young atopic woman.

Histamine fish poisoning, also known as scombroid poisoning, is a histamine toxicity syndrome that results from eating specific types of spoiled fish. Although typically a benign syndrome, characterized by self-limited flushing, headache, and gastrointestinal symptoms, we describe a case unique in its severity and as a precipitant of an asthma exacerbation. A 25-year-old woman presented to the emergency department (ED) with one hour of tongue and face swelling, an erythematous pruritic rash, and dyspnea with wheezing after consuming a tuna sandwich. She developed abdominal pain, diarrhea and hypotension in the ED requiring admission to the hospital. A diagnosis of histamine fish poisoning was made and the patient was treated supportively and discharged within 24 hours, but was readmitted within 3 hours due to an asthma exacerbation. Her course was complicated by recurrent admissions for asthma exacerbations.

Development of a real-time PCR assay with an internal amplification control for detection of Gram-negative histamine-producing bacteria in fish.

Prompt detection of bacteria that contribute to scombrotoxin (histamine) fish poisoning can aid in the detection of potentially toxic fish products and prevent the occurrence of illness. We report development of the first real-time PCR method for rapid detection of Gram-negative histamine-producing bacteria (HPB) in fish. The real-time PCR assay was 100% inclusive for detecting high-histamine producing isolates and did not detect any of the low- or non-histamine producing isolates. The efficiency of the assay with/without internal amplification control ranged from 96-104% and in the presence of background flora and inhibitory matrices was 92/100% and 73-96%, respectively. This assay was used to detect HPB from naturally contaminated yellowfin tuna, bluefish, and false albacore samples. Photobacterium damselae (8), Plesiomonas shigelloides (2), Shewanella sp. (1), and Morganella morganii (1) were subsequently isolated from the real-time PCR positive fish samples. These results indicate that the real-time PCR assay developed in this study is a rapid and sensitive method for detecting high-HPB. The assay may be adapted for quantification of HPB, either directly or with an MPN-PCR method.

[Analysis of notifications on exceeding of the acceptable level of histamine according to the RASFF reports]. / Analiza powiadomien dotyczacych przekroczen dopuszczalnego poziomu histaminy na podstawie raportów RASFF.

The histamine is biogenic amine produced in considerable amounts in fish and fish products contaminated with bacteria. Histamine content in fish should not exceed 200 mg/kg, higher levels can cause poisoning and the concentrations above 1000 mg/kg are toxic and may be dangerous for man. The Rapid Alert System for Food and Feed (RASFF) notifies the exceedances of the permissible level of histamine. In the years 2003-2009 there have been 272 notifications, including 72 alarm and 178 information. High histamine content in tuna exceeding the permissible level up to more than 40-fold (8299 mg/kg), in coryfena (mahi-mahi), more than 17-fold (3490 mg/kg), sardines 9-fold (1820 mg/kg), anchovii (anchovies) and 8-fold (1630 mg/kg) and fish sauce over a 7-fold (1467 mg/kg) was observed.

Differential characterization of biogenic amine-producing bacteria involved in food poisoning using MALDI-TOF mass fingerprinting.

Histamine poisoning is caused by the consumption of fish and other foods that harbor bacteria possessing histidine decarboxylase activity. With the aim of preventing histamine formation, highly specific mass spectral fingerprints were obtained from the 16 major biogenic amine-producing enteric and marine bacteria by means of MALDI-TOF MS analysis. All bacterial strains analyzed exhibited specific spectral fingerprints that enabled its unambiguous differentiation. This technique also identified peaks common to certain bacterial groups. Thus, two protein peaks at m/z 4182+/-1 and 8363+/-6 were found to be present in all Enterobacteriaceae species analyzed except for Morganella morganii. Peaks at m/z 3635+/-1 and 7267+/-2 were specific to both M. morganii and Proteus spp. Biogenic amine-forming Proteus spp. exhibited three genus-specific peaks at m/z 3980, 7960+/-1 and 9584+/-2. The genus Photobacterium also showed three genus-specific peaks at m/z 2980+/-1, 4275+/-1 and 6578+/-1. The two histamine-producing Gram-positive bacteria Lactobacillus sp. 30A and Staphylococcus xylosus exhibited a few protein peaks in the 2000-7000 m/z range and could be easily distinguished from biogenic amine-forming Gram-negative bacteria. Clustering based on MALDI-TOF MS also exhibited a good correlation with phylogenetic analysis based on the 16S rRNA gene sequence, validating the ability of the MALDI-TOF technique to establish relationships between microbial strains and species. The approach described in this study leads the way toward the rapid and specific identification of major biogenic amine-forming bacteria based on molecular protein markers with a goal to the timely prevention of histamine food poisoning.

Barriers to surge capacity of an overcrowded emergency department for a serious foodborne disease outbreak.

OBJECTIVE: The purpose of this study was to investigate barriers to surge capacity of an overcrowded emergency department (ED) for a foodborne disease outbreak (FBDO) and to identify solutions to the problems. DESIGN: The emergency response of an overcrowded ED to a serious FBDO with histamine fish poisoning was reviewed. SETTING: The ED of a tertiary academic medical centre (study hospital) with 1600 acute beds in southern Taiwan. RESULTS: Among the 346 patients in the outbreak, 333 (96.2%) were transferred to the study hospital without prehospital management within about 2 h. The most common symptoms were dizziness (58.9%), nausea and vomiting (36.3%). 181 patients (54.4%) received intravenous fluid infusion and blood tests were ordered for 82 (24.6%). All patients were discharged except one who required admission. The prominent problems with surge capacity of the study hospital were shortage of spare space in the ED, lack of biological incident response plan, poor command system, inadequate knowledge and experience of medical personnel to manage the FBDO. CONCLUSIONS: Patients with FBDO could arrive at the hospital shortly after exposure without field triage and management. The incident command system and emergency operation plan of the study hospital did not address the clinical characteristics of the FBDO and the problem of ED overcrowding. Further planning and training of foodborne disease and surge capacity would be beneficial for hospital preparedness for an FBDO.

Histamine Fish Poisoning and Histamine Production by Raoultella ornithinolytica in Milkfish Surimi.

ABSTRACT: In April 2017, an outbreak of histamine fish poisoning causing illness in nine victims associated with consumption of milkfish surimi products (fish ball) occurred in Kaohsiung City, southern Taiwan. Of the two suspected frozen milkfish surimi samples, one sample contained 91.06 mg/100 g of histamine, levels that are greater than the potential hazard action level (50 mg/100 g) in most illness cases. Moreover, 28 frozen milkfish surimi samples from retail stores were collected and tested to determine the occurrence of histamine. One (3.6%) of 28 commercial surimi samples had histamine levels greater than the U.S. Food and Drug Administration (FDA) guideline for decomposition of 5 mg/100 g for scombroid fish and/or products. Thirteen histamine-producing bacterial strains isolated from suspected and commercial surimi samples were identified as prolific histamine formers, able to produce 98.4 to 121.8 mg/100 mL of histamine in Trypticase soy broth supplemented with 1.0% l-histidine. In addition, milkfish surimi was inoculated with Raoultella ornithinolytica at 5.0 log CFU/g and stored at 4, 15, 25, and 37°C to investigate bacterial growth and formation of histamine. The histamine contents quickly increased to more than 50 mg/100 g in samples stored at 37 and 25°C within 12 and 24 h, respectively, as well those stored at 15°C within 96 h. To our knowledge, this is the first report in Taiwan to demonstrate that milkfish surimi products could cause histamine intoxication.

[Scombroid food poisoning among hospital personnel]. / Scombroïde-intoxicatie onder ziekenhuispersoneel.

BACKGROUND: Scombroid food poisoning is caused by eating fish with a high concentration of histamine. Histamine is converted from histidine in fish of the Scombroidea family if it is not stored at a sufficiently low temperature. The clinical picture resembles an allergic reaction. CASE DESCRIPTION: Twenty-one of our hospital personnel went to the ER, mostly reporting flushing, headache, palpitations and gastro-intestinal symptoms. They had all eaten tuna salad in the staff canteen. The symptoms appeared to be caused by scombroid food poisoning. CONCLUSION: As a result of early recognition of the clinical picture and prompt crisis management we were able to prevent the outbreak spreading further.

[Histamine food poisonings in Japan and other countries].

Histamine food poisonings are allergy-like food poisonings caused by the ingestion of spoiled fish containing markedly elevated histamine levels. We examined histamine food poisonings in Japan from 1998 to 2008. In average 8 food poisonings and 150 cases were reported annually and there was no fatality case. In more than 80% of remaining food samples, histamine content exceeded 20 mg/100 g. These poisonings were caused by tuna, billfish (marlin) and mackerel, which contained higher level of histamine than other fishes in histamine food poisonings in Japan. Cooking methods of these fishes were mainly "broiled". We also studied histamine food poisonings in other countries. Tuna was the main fish in histamine food poisonings reported to Centers for the Disease Control and Prevention (CDC) in the US and Ozfoodnet in Australia from 2000 to 2006. In the US, histamine food poisonings were also caused by mahimahi and escolar fish. Our review will be useful for in taking measures to reduce risk of histamine food poisonings.

Rare Death Via Histamine Poisoning Following Crab Consumption: A Case Report.

Histamine poisoning (scombroid food poisoning) is a toxicity syndrome that results from eating spoiled fish. To date, however, few poisoning (or mortality) cases have been reported in relation to crab consumption. Here, we describe a very uncommon case in which a 37-year-old woman and her 14-year-old son ate cooked crabs (Scylla serrata), resulting in the death of the female. Samples of vomitus, food residue, liver tissue, gastric content, intestinal content, and cardiac blood were analyzed by high-performance liquid chromatography. Toxicological analysis revealed that histamine concentrations were very high in the cooked crab (47.08 mg/100 g) and intestinal content (22.54 mg/100 g). Comparing our toxicological results, police investigations, and family member statements, it can be assumed that the decedent ingested spoiled crabs, and by excluding other causes of death, lethal intoxication with histamine poisoning was confirmed.

Histamine poisoning from insect consumption: an outbreak investigation from Thailand.

BACKGROUND: Insect consumption is a common practice in the Asian culture and all over the world. We are reporting an outbreak investigation of histamine poisoning from ingestion of fried insects. METHODS: On 24 July 2014, a group of students at a seminar presented to Angthong Provincial Hospital, Thailand, with pruritic rash after ingesting snacks consisting of fried insects from a vendor. We initiated an outbreak investigation with retrospective cohort design and collected samples of remaining foods for analyses. Attack rates, relative risks and their confidence intervals (CI) were calculated. RESULTS: Out of 227 students, 28 developed illnesses that were consistent with our case definition which included, flushing, pruritus, urticarial rashes, headache, nausea, vomiting, diarrhea, dyspnea and bronchospasm. Two children were hospitalized for progressive bronchospasm overnight without serious complications. The types of food ingested included a lunch that was provided at the seminar for all students and snacks that 41 students bought from the only vendor in the vicinity. The snacks included fried grasshoppers, silkworm pupae, common green frogs, bamboo borers, crickets and meat balls. The attack rates were highest (82.6 and 85.0%) among students who ingested fried grasshoppers and silkworm pupae and lowest (4.4 and 5.3%) among those who did not ingest them, with relative risk of 18.7 (95% CI 9.6-36.4) for grasshoppers and 16.0 (95% CI 8.8-29.3) for silkworm pupae. Histamine concentrations in the fried grasshoppers and silkworm pupae were 9.73 and 7.66 mg/100g, respectively. DISCUSSION AND CONCLUSION: Through epidemiological analysis and laboratory confirmation, we have illustrated that histamine poisoning can occur from ingestion of fried insects. We postulate that histidine, which is present in high concentration in grasshoppers and silkworm pupae, is decarboxylated by bacteria to histamine, a heat stable toxin. The ingestion of histamine is responsible for the clinical pictures being reported.

Real-time polymerase chain reaction for quantitative detection of histamine-producing bacteria: use in cheese production.

Biogenic amines are toxic substances that appear in foods and beverages as a result of AA decarboxylation. The enzyme histidine decarboxylase catalyzes the decarboxylation of histidine to histamine, the biogenic amine most frequently involved in food poisoning. The aim of the present work was to develop a real-time quantitative PCR assay for the direct detection and quantification of histamine-producing strains in milk and cheese. A set of primers was designed, based on the histidine decarboxylase gene sequence of different gram-positive bacteria. The results show the proposed procedure to be a rapid (total processing time < 2 h), specific and highly sensitive technique for detecting potential histamine-producing strains. Chromatographic methods (HPLC) verified the capacity of real-time quantitative PCR to correctly quantify histamine accumulation.

An outbreak of histamine poisoning after ingestion of the ground saury paste in eight patients taking isoniazid in tuberculous ward.

OBJECTIVE: To determine the cause of outbreak mimicking food poisoning, we studied the toxic polyamine contents of the food and analyzed the clinical characteristics of the affected eight patients. PATIENTS AND METHODS: Eight cases of histamine poisoning which occurred in tuberculous patients after dinner in our hospital were analyzed by clinical and biochemical methods. We examined the contents of four representative toxic polyamines, histamine, putrescine, cadaverine and tyramine, of the each food of the dinner and their serum concentrations of the monoamine oxidase (MAO), one of histaminases, using radioimmunoassay. RESULTS: The allergy-like symptoms such as flushing, headache, palpitation, itching, wheezing, dyspnea and diarrhea appeared from 20 minutes to two hours after ingestion in those eight patients taking isoniazid (INH), although the other 378 inpatients had no symptom. The histamine content of the ground saury paste was increased to 32 mg/100 g of food, however, the toxic level of food poisoning is less than 50 mg/100 g of food. All eight patients were taking INH, and their serum concentrations of MAO were decreased. CONCLUSION: We concluded that this accident was the histamine fish poisoning. We speculated that those allergy-like symptoms were due to both the increased histamine in the food made with the saury under poor storage conditions and the patients' reduced histaminase activities due to INH. We should perceive possible adverse effects depending on the interactions between certain drugs and food.

[Outbreak due to butterfish consumption: keriorrhea and histamine poisoning]. / Brote epidémico por consumo de pez mantequilla: keriorrea e intoxicación histamínica.

BACKGROUND: The consumption of butterfish is spreading in our country; if appropriate standards of conservation and preparation of this type of food are not met may cause poisoning. The objective is to describe an outbreak of histamine poisoning and double cerous esters after consumption butterfish. METHODS: A descriptive study of the double intoxication at a banquet held in July 2013 in Valladolid. It was studied by filling a specific survey, by phone or by the medical centers who treated the guests. The database and subsequent descriptive statistical analyzes were performed with Microsoft Excel Professional Plus 2010 program. RESULTS: Of the 27 cases reported in 24 we obtained information on symptoms. The attack rate was 22.5 %, with a clinical picture in which predominant diarrhea (75%), headache (46%), abdominal pain (38%) and sweating (38%), highlighting its specificity itching/burning of mouth (29%). Four patients had orange and oily stools (keriorrhea). The average time from the start of dinner to onset of symptoms was 119 minutes. The mean duration of symptoms was 14 hours. Analytical served fish showed histamine levels above 2,000 mg / kg. CONCLUSIONS: A double poisoning (histamine and cerous esters) was produced by consumption of butterfish. The picture was mild and self-limiting. You need to know this type of poison to properly handle avoiding unnecessary tests, and to notify the health authority for investigation and subsequent adoption of appropriate measures.

Bronchial reactivity increases soon after the immediate response in dual-responding asthmatic subjects.

To determine whether bronchial reactivity is augmented soon after an allergen-induced immediate asthmatic response, we compared reactivity to histamine before and immediately upon resolution of the immediate asthmatic response in seven subjects with mild asthma who were known to develop dual asthmatic responses after inhalation of Kentucky bluegrass allergen. Using a body plethysmograph and quiet breathing technique, specific airway resistance (SRaw) and reactivity to aerosol histamine were assessed on two days prior to allergenic challenge. The dose of histamine that doubled SRaw (PC200His) was determined by interpolation from histamine dose-response curves. On the day of allergenic challenge, each subject inhaled a concentration that was sufficient to induce a dual asthmatic response. Upon resolution of the immediate asthmatic response (45 to 105 minutes) after allergen, the PC200His in all cases had decreased more than 50 percent of its original value (PC200His for the group was 0.29 +/- 1.42 mg/ml [mean +/- SE], compared to 0.84 +/- 1.23 mg/ml initially). Seven or more days after the allergen, each subject had a PC200His comparable to original values. Our data indicate that airway reactivity in dual-responding asthmatic subjects markedly increases soon after the immediate asthmatic response and much before the late asthmatic response manifests clinically. Whether this early increase in bronchial reactivity is a putative requirement for, or shares common characteristics with the late asthmatic response requires further study.

Histamine fish poisoning revisited.

Histamine (or scombroid) fish poisoning (HFP) is reviewed in a risk-assessment framework in an attempt to arrive at an informed characterisation of risk. Histamine is the main toxin involved in HFP, but the disease is not uncomplicated histamine poisoning. Although it is generally associated with high levels of histamine (> or =50 mg/100 g) in bacterially contaminated fish of particular species, the pathogenesis of HFP has not been clearly elucidated. Various hypotheses have been put forward to explain why histamine consumed in spoiled fish is more toxic than pure histamine taken orally, but none has proved totally satisfactory. Urocanic acid, like histamine, an imidazole compound derived from histidine in spoiling fish, may be the "missing factor" in HFP. cis-Urocanic acid has recently been recognised as a mast cell degranulator, and endogenous histamine from mast cell degranulation may augment the exogenous histamine consumed in spoiled fish. HFP is a mild disease, but is important in relation to food safety and international trade. Consumers are becoming more demanding, and litigation following food poisoning incidents is becoming more common. Producers, distributors and restaurants are increasingly held liable for the quality of the products they handle and sell. Many countries have set guidelines for maximum permitted levels of histamine in fish. However, histamine concentrations within a spoiled fish are extremely variable, as is the threshold toxic dose. Until the identity, levels and potency of possible potentiators and/or mast-cell-degranulating factors are elucidated, it is difficult to establish regulatory limits for histamine in foods on the basis of potential health hazard. Histidine decarboxylating bacteria produce histamine from free histidine in spoiling fish. Although some are present in the normal microbial flora of live fish, most seem to be derived from post-catching contamination on board fishing vessels, at the processing plant or in the distribution system, or in restaurants or homes. The key to keeping bacterial numbers and histamine levels low is the rapid cooling of fish after catching and the maintenance of adequate refrigeration during handling and storage. Despite the huge expansion in trade in recent years, great progress has been made in ensuring the quality and safety of fish products. This is largely the result of the introduction of international standards of food hygiene and the application of risk analysis and hazard analysis and critical control point (HACCP) principles.

Histamine poisoning after ingestion of spoiled raw tuna in a patient taking isoniazid.

An 83-year-old woman taking isoniazid (INH) suddenly developed a headache, palpitations, and skin eruptions with itching while eating raw tuna. The symptoms were compatible with those of histamine intoxication. When given fresh raw tuna to eat, no such reactions were evoked in this patient. The episode was speculated to be due to two conditions; eating spoiled raw tuna and at the same time being on a course of INH, a potent histaminase inhibitor. We should therefore be aware of the possible adverse effects due to the interactions between drugs and foods.

Seafood-associated diseases and control in Canada.

Paralytic shellfish poisoning (PSP) has been documented for two centuries and control programmes have been operated for fifty years. Although some illnesses are reported almost every year, the last known death from PSP occurred in 1981. In more recent years, amnesic shellfish poisoning, ciguatera poisoning, diarrhoetic shellfish poisoning, scombroid (histamine) poisoning and tetramine poisoning have been documented. The most frequently observed of these diseases is scombroid poisoning from improperly stored fish, but PSP and ciguatera poisoning have the most serious consequences. Vibrio infections arising from naturally-contaminated shellfish are virtually unknown, and viral illnesses from polluted harvested waters are rare. Control is achieved through monitoring of waters for indicators of human pathogens. Inspection systems based on the hazard analysis and critical control point principles are being introduced into all areas of fish and shellfish harvesting. The Inspection Directorate of the Department of Fisheries and Oceans joined the new Canadian Food Inspection Agency in 1997, which co-ordinates all Federal control measures for food in Canada.