Histamine-Induced Allergic Outbreak in among Junior/ Senior High School Students - A Case-Control Study

Donald Dah-Shyong Jiang

2009 Vol.25 NO.5

Correspondence Author: Donald Dah-Shyong Jiang


On January 13, 2009, several students at X Junior/Senior High School in Kaohsiung City started to show allergic symptoms of flushed faces, irregular heart rates, dizziness, and vomiting and were sent for medical assistance. Epidemiological case-control investigation is conducted in order to determine the scale of the outbreak, the cause, and the food responsible for the episode.
According to the 818 questionnaires distributed and collected from the classes with students showed allergic symptoms, a total of 777 students consumed the school lunch on January 13. Among these 777 persons, 71 fit the case definition, with 32 males (45.1%) and 39 females (54.9%), showing an attack rate of 9.14%. The case symptoms were (in order) dizziness (67.6%), flushed faces (63.4%), increase heart rates (50.7%), nausea (45.1%), abdominal pains (32.4%), headache (43.7%), chillness (29.6%), short of breath (19.1%), vomiting (18.3%), and fever (15.5%). The incubation period was between <1 and 8 hours with a medium of 1 hour. Test results show that the histamine found in a fried sailfish fillet specimen was 377.4 ppm. Results of the logistic regression analysis of the single dish and multiple dishes of the school lunch on January 13 showed that the risk factor of the outbreak was the fried sailfish fillet which induced the histamine fish poisoning outbreak (OR: 2.987, 95% CL: 1.268-7.036).
According to the case symptoms, incubation period, results of both statistical analysis of the school lunch contents and food residual (from the fried sailfish fillet) tests, we can conclude that the allergic symptoms in the students were a histamine-induced fish poisoning outbreak. The cause of the outbreak was histamine which originated from the fried sailfish fillet.
Keywords: food poisoning, allergic symptoms, histamine, outbreak, case-control study