Authors’ response to letter “Tryptase serum level as a possible indicator of scombroid syndrome” by Jang, Nelson, and Hoffman

To the Editor:

We are pleased to respond to the letter from Jang and colleagues. Obviously we do not routinely recommend gastric lavage or use of active charcoal for all patients with histamine fish poisoning. We believe there may, however, be a place for decontamination in severe cases, with unresponsive hypotension or severe tachycardia, occurring within 1 h of ingestion. We do not ignore the risks of these decontamination methods, and we recommend them only if the clinical condition of the patient is serious.¹

We agree that this condition is generally easily diagnosed and responds well to conventional therapies, but we must emphasize that this is true only when you have in your mind that the scombroid syndrome is present, and would remind readers this diagnosis is often missed.²

In our experience some cases require aggressive treatment in intensive care, as described also by others.¹ Severe scombroid syndrome remains a challenging differential diagnosis in the emergency department.