About This Disease

Scombroid fish poisoning is an illness that is caused by eating spoiled fish. During the catching, handling, and processing of fish, the temperature of the fish is compromised and histidine is converted to histamine.

Signs and Symptoms

  • A sharp metallic or peppery taste and itching around the mouth while eating the fish;
  • Reddening of the face and sometimes the neck, arms, and upper part of the trunk;
  • Severe headache, rapid heartbeat; stomach cramps, nausea, and diarrhea;
  • Burning sensation in the throat.
  • Symptoms begin within 30 minutes to a couple hours after eating spoiled fish containing >25mg of histamine.


The fish most associated with Scombroid are ahi, mahimahi, bonito, aku, albacore, mackerel, sardines, and anchovies.


A physician will make a clinical diagnosis based on symptoms and type of fish eaten. There is no laboratory test for humans to identify Scombroid.


Treatment is often unnecessary, but antihistamines or epinephrine can help in many cases.

Risk in Hawaii

The risk is very high for Scombroid fish poisoning in Hawaii. Hawaii averages about 25 cases a year.


  • Promptly clean and cook mackerel family type fish to avoid spoilage.
  • Make sure fish is at proper temperature when purchasing at store.
  • Be cautious if you detect any unusual “sharp”, “metallic”, or “peppery” taste when eating fish.

Information for Clinicians

Scombroid fish poisoning is a reportable disease Hawaii Administrative Rules Title 11 Chapter 156, Communicable Diseases, under the Urgent category which requires a report by telephone to the Disease Outbreak Control Division on Oahu or to the District Health Offices on the neighbor islands as soon as a provisional diagnosis has been established. The telephone report shall be followed by a written report submitted by mail or fax within three days to Disease Outbreak Control Division on Oahu or to the District Health Offices on the neighbor islands.


Last reviewed December 2023