The toxin forms in a food when certain bacteria are present and time and temperature permit their growth. Distribution of the toxin within an individual fish fillet or between cans in a case lot can be uneven, with some sections of a product causing illnesses and others not. Neither cooking, canning, or freezing reduces the toxic effect. Common sensory examination by the consumer cannot ensure the absence or presence of the toxin. Chemical testing is the only reliable test for evaluation of a product.
Scombroid poisoning remains one of the most common forms of fish poisoning in the United States.
Even so, incidents of poisoning often go unreported because of the lack of required reporting, a lack of information by some medical personnel, and confusion with the symptoms of other illnesses. Difficulties with underreporting are a worldwide problem. A defect action level for histamine in canned tuna resulted in increased industry quality control. Secondly, blocklisting of mahi mahi reduced the level of fish imported to the United States. The onset of intoxication symptoms is rapid, ranging from immediate to 30 minutes.