Fishy Reaction

Off tuna

Miami may be a fabulous place for a free spirit, but it's a darn tough town for a lady. For one thing table manners and dining etiquette are all but impossible to pursue when the restaurant employees don't even set silverware properly. So I've been shifting a great many forks to the left side of the charger lately and aligning more than a few water glasses with butter knives. But good thing I'm hardly a lady, especially considering the amount of suspicious, half-chewed shellfish I've deposited into napkins lately.

It's not to be rude. I have been determined to avoid illnesses caused by E.coli or lysteria this summer, during which "about 80 million Americans -- approximately one in three -- will suffer the nasty effects of food poisoning," eDiets.com reports. Thanks to our subtropical heat, I would think we Miamians are easily at risk of making up a goodly proportion of that 80 million. So if something seems the least bit off when it goes in my mouth, without the least bit of hesitation it comes right out.

Unfortunately you can't always tell if food has been contaminated by the way it tastes, as my editor and I recently discovered. We were dining at a popular restaurant I will call Al Jones* (*names have been changed to protect the alleged). Halfway through her tuna entrée, which she was enjoying wholeheartedly, she began to turn as red as a tourist who had forgotten to apply sunscreen. Within minutes her face, arms, neck, and chest became puffy and itchy, and by the time she got home, even her kneecaps had turned scarlet.

Jeremy Eaton

At the time she wrote it off as an allergic reaction, similar to the one she gets when she ingests monosodium glutamate (MSG), and I have to admit I teased her a bit about her florid coloring. But I wasn't feeling nearly so jocular about four hours later, when my body began to violently reject the meat loaf I had consumed for dinner. Coincidence? Probably not. Although we had radically different symptoms and ate completely separate foodstuffs (without sharing, I should note), we both appeared to have contracted food-borne illnesses from the kitchen. My symptoms -- excessive vomiting, chills and fever, muscle aches and pains -- will sound familiar to anyone who has weathered invasions of staph or salmonella, the latter of which the American Medical Association Encyclopedia of Medicine calls "the bacteria most commonly responsible for food poisoning." I've encountered salmonella before, most memorably at the erstwhile Sweet Donna's in South Miami, and I know from both these experiences that it's also true that "a large colony of [salmonella] bacteria may develop without obvious food spoilage." In other words your food tastes just fine -- on the way in, that is.

However, salmonella, of which there are about 1600 types, is hard to prove. Experts suggest you go to a hospital emergency room if you suspect you have contracted salmonella, but most victims find themselves too unwell to leave the bathroom. Even if you do manage to get yourself to a doctor, chances are no one will bother to analyze the contents of your stomach (or leftovers, should you have them) unless a large number of people have become life-threateningly ill, as with the case of E.coli outbreaks. Rather you'll be diagnosed empirically, treated with intravenous solutions to keep you from dehydrating and maybe some anti-nausea medication, and then released.

The cause of the face and body reddening -- scombroid poisoning -- is even more difficult to diagnose and prove. Scombroid is named after the scombridae family of fish, including tuna, mackerel, and bluefish, which are prone to spoiling if not stored both properly and immediately. The bacteria that grow on the fish produce histamine as a byproduct, quickly creating le Clemson University notes that "toxic histamine levels can be generated within less than six to twelve hours exposure without ice or refrigeration."

Unlike salmonella and such, signs of scombroid poisoning will appear very quickly, usually while a person is still consuming the affected fish. These symptoms, which include tingling, burning, and itching in the mouth or throat along with an upper-body rash, resemble an allergic reaction, and the effective treatment for the poisoning -- antihistamine medication or steroids -- may lead physicians to make incorrect diagnoses. And unless the fish itself is analyzed for elevated histamine levels within a couple of hours, chances are the patient will be told he or she suffers from a seafood allergy.

This is precisely what happened to a friend who purportedly contracted scombroid poisoning from another piece of tuna at a well-known steak house we'll refer to as Capitol Hill.* Because this particular friend has asthma, he was worried enough by his bizarre symptoms that he went to the hospital. There he was given a bed pan, Pepcid, a short course of Prednisone, and a diagnosis of a tuna allergy -- despite the fact that he'd eaten tuna three times earlier that week with no evil consequences.

If physicians are undereducated about scombroid poisoning, you can bet the rest of the population is even more so -- and that includes chefs and restaurateurs. A few months ago the Journal of the American Medical Association reported a rash of scombroid poisoning, the result of tuna burgers appearing more commonly on menus these days; the grinding apparently heats up the tuna sufficiently that the spoiling begins early on. Down here in the subtropics, refrigeration is the key to food safety in restaurants. In our case the sole link between illnesses seems to be that both tuna and meat loaf were allowed to sit out and grow harmful bacteria, albeit different varieties -- which, quite frankly, is even scarier than if only one type of food had been affected. So restaurants: Get thy fish and meat in out of the heat tout suite.

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