Publication: Histamine poisoning from insect consumption: an outbreak investigation from Thailand
Issued Date
2018-02-01
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15569519
15563650
15563650
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2-s2.0-85026374206
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Toxicology. Vol.56, No.2 (2018), 126-131
Suggested Citation
Summon Chomchai, Chulathida Chomchai Histamine poisoning from insect consumption: an outbreak investigation from Thailand. Clinical Toxicology. Vol.56, No.2 (2018), 126-131. doi:10.1080/15563650.2017.1349320 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/47326
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Title
Histamine poisoning from insect consumption: an outbreak investigation from Thailand
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Abstract
© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: Insect consumption is a common practice in the Asian culture and all over the world. We are reporting an outbreak investigation of histamine poisoning from ingestion of fried insects. Methods: On 24 July 2014, a group of students at a seminar presented to Angthong Provincial Hospital, Thailand, with pruritic rash after ingesting snacks consisting of fried insects from a vendor. We initiated an outbreak investigation with retrospective cohort design and collected samples of remaining foods for analyses. Attack rates, relative risks and their confidence intervals (CI) were calculated. Results: Out of 227 students, 28 developed illnesses that were consistent with our case definition which included, flushing, pruritus, urticarial rashes, headache, nausea, vomiting, diarrhea, dyspnea and bronchospasm. Two children were hospitalized for progressive bronchospasm overnight without serious complications. The types of food ingested included a lunch that was provided at the seminar for all students and snacks that 41 students bought from the only vendor in the vicinity. The snacks included fried grasshoppers, silkworm pupae, common green frogs, bamboo borers, crickets and meat balls. The attack rates were highest (82.6 and 85.0%) among students who ingested fried grasshoppers and silkworm pupae and lowest (4.4 and 5.3%) among those who did not ingest them, with relative risk of 18.7 (95% CI 9.6–36.4) for grasshoppers and 16.0 (95% CI 8.8–29.3) for silkworm pupae. Histamine concentrations in the fried grasshoppers and silkworm pupae were 9.73 and 7.66 mg/100g, respectively. Discussion and conclusion: Through epidemiological analysis and laboratory confirmation, we have illustrated that histamine poisoning can occur from ingestion of fried insects. We postulate that histidine, which is present in high concentration in grasshoppers and silkworm pupae, is decarboxylated by bacteria to histamine, a heat stable toxin. The ingestion of histamine is responsible for the clinical pictures being reported.