Caused by eating fish which have been improperly stored/refrigerated
Bacteria grow and convert histidine in fish via histidine decarboxylase to histamine and histamine-like substances responsible for symptoms
Patient may complain that the fish tasted like pepper, metallic, or bitter
Frequently misdiagnosed as seafood allergy
Most common incidence in US is state of Hawaii, followed by Florida 
Bacteria grow and convert histidine in fish via histidine decarboxylase to histamine and histamine-like substances responsible for symptoms
Patient may complain that the fish tasted like pepper, metallic, or bitter
Ingestion of:
Fish
Tuna
Bluefish
Mahi-mahi
Herring
Mackerel
Skip-jack
Sardine
Bonito
Swiss cheese (contaminated)
Tuna
Bluefish
Mahi-mahi
Herring
Mackerel
Skip-jack
Sardine
Bonito
Scombroid
Ciguatera - similar clinical presentation, different fish
Clitocybe
Allergic reaction/urticaria
Inocybe
Anaphylaxis
Chalazion
Angioedema