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Scombroid is caused by ingestion of preformed histamine on skin of fish.
- Naturally occurring histidine on scaly fish converted to histamine by surface bacteria - often fish left out too long, refrigeration will prevent the conversion.
- Bacteria responsible are Morganelli morganii and K. pneumoniae
- Fish: tuna, mahi mahi, amberjack, bonito, mackerel, albacore
- Fish usually appears normal though meat may tast peppery
- Patient presents minutes/hrs flushed, urticaria, HA, N/V
- Self-limited and improve within hrs even without treatment
- Antihistamines and rarley epinephrine will be needed