Anaphylactic Death: A New Forensic Workflow for Diagnosis.
anaphylactic death
blood tryptase level
diagnostic workflow
immunohistochemical investigation
Journal
Healthcare (Basel, Switzerland)
ISSN: 2227-9032
Titre abrégé: Healthcare (Basel)
Pays: Switzerland
ID NLM: 101666525
Informations de publication
Date de publication:
22 Jan 2021
22 Jan 2021
Historique:
received:
18
12
2020
revised:
11
01
2021
accepted:
20
01
2021
entrez:
27
1
2021
pubmed:
28
1
2021
medline:
28
1
2021
Statut:
epublish
Résumé
Anaphylaxis is a life-threatening or fatal clinical emergency characterized by rapid onset, and death may be sudden. The margin of certainty about the diagnosis of anaphylactic death is not well established. The application of immunohistochemical techniques combined with the evaluation of blood tryptase concentrations opened up a new field of investigation into anaphylactic death. The present study investigated eleven autopsy cases of anaphylactic death, carried out between 2005 and 2017, by the Departments of Forensic Pathology of the Universities of Foggia and Catania (Italy). An analysis of the medical records was carried out in all autopsies. Seven autopsies were carried out on males and four on females. Of the eleven cases, one showed a history of asthma, one of food ingestion, two of oral administration of medications, six did not refer any allergy history, and one subject was unknown. All cases (100%) showed pulmonary congestion and edema; 7/11 (64%) of the cases had pharyngeal/laryngeal edema and mucus plugging in the airway; only one case (9%) had a skin reaction that was found during external examination. Serum tryptase concentration was measured in ten cases, and the mean value was 133.5 µg/L ± 177.9. The immunohistochemical examination using an anti-tryptase antibody on samples from the lungs, pharynx/larynx, and skin site of medication injection showed that all cases (100%) were strongly immunopositive for anti-tryptase antibody staining on lung samples; three cases (30%) were strongly immunopositive for anti-tryptase antibody staining on pharyngeal/laryngeal samples; and eight cases (80%) were strongly immunopositive for anti-tryptase antibody staining on skin samples. We conclude that a typical clinical history, blood tryptase level >40 µg/L, and strongly positive anti-tryptase antibody staining in the immunohistochemical investigation may represent reliable parameters in the determination of anaphylactic death with the accuracy needed for forensic purposes.
Identifiants
pubmed: 33499408
pii: healthcare9020117
doi: 10.3390/healthcare9020117
pmc: PMC7911323
pii:
doi:
Types de publication
Journal Article
Langues
eng
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