Fish allergy is well recognized, however scombroid poisoning or histamine fish poisoning, which exhibits identical clinical manifestations, is rarely diagnosed. We report the case of a 28-year-old female who, after eating tuna spaghetti, experienced a flushed face, generalized erythema, angioedema, shock and tachypnea requiring adrenaline, chlorpheniramine, ranitidine, and hydrocortisone injections. Her symptoms completely resolved within 3 hours. Her condition was diagnosed as scombroid poisoning based on temporality, normal serum tryptase levels (2.7 ng/mL) at 2.5 hours and at her baseline (2.5 ng/mL, 60 hours), as well as negative results on skin-prick test and re-challenging one can of the same branded-tuna orally. The revelant public health authorities were notified and a restaurant-visit was made, although the tuna can from which the patient’s dish was prepared had been discarded, hence a histamine analysis of the tuna was unavailable. This case underscores the need for awareness of scombroid poisoning and public interventions regarding food safety.