To the Editor: Dr Becker and colleagues1 reported an increased incidence of histamine poisoning associated with eating tuna burgers in North Carolina. While the general population may be consuming more seafood, the study offers no proof that this change in dietary habit has resulted in more cases of histamine poisoning.
Patients were identified through data passively reported to local and state health and agriculture departments. This type of data is susceptible to wide fluctuations in accuracy and completeness of case reporting. Overreporting is likely during times of high media exposure, and this remains a possible explanation for the dramatic increase in disease found by the authors. This type of data is unbiased only when every case is reported and verified or actively collected. The bias is magnified by the vague diagnostic criteria used to define a case of histamine poisoning. The finding of 2 nonspecific symptoms, such as rash, vomiting, or diarrhea, within 2 hours of eating fish does not confirm that a patient has histamine poisoning.
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