Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. The Study Sample
3.2. Anti-Tryptase Antibody
3.3. Anti-Chimase Antibody
3.4. Anti-CD117 Antibody
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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References | no. | Age (Mean) | Sex | Molecule | Control Group no. (Cause of Death) | Sample |
---|---|---|---|---|---|---|
Fineschi et al. (2001) [6] | 32 | Not reported | Not reported | Anti-tryptase antibody | 48 (heroin-related deaths) 44 (head trauma) | Lung |
Edston et al. (1999) [7] | 1 | 6–495 days | M (24) F (20) | Anti-tryptase antibody | N/A | Lung |
Perskvist et al. (2007) [8] | 9 | 17–55 (39) | M (7) F (1) | Anti-tryptase and anti-chymase antibody | 20 (Asthma) 20 (Generic Natural causes) | Heart, Lung |
Osawa et al. (2008) [9] | 3 | 46–74 (58.6) | M (3) | Anti-tryptase and anti-chymase antibody | N/A | Lung |
Turillazzi et al. (2008) [10] | 1 | 33 | F | Anti-tryptase antibody | N/A | Lung |
Trani et al. (2008) [11] | 4 | 53–65 (60) | M (3) F (1) | Anti-tryptase antibodies and anti-chymase antibody | N/A | Spleen |
Unkrig et al. (2010) [12] | 1 | 52 | F | Anti-CD117 and anti-tryptase antibody | N/A | Glottis, Lung, Intestinal tissue |
Luongo et al. (2011) [13] | 2 | 30–47 | M (2) | Anti-CD117 and anti-tryptase antibody | N/A | Glottis |
Edston et al. (2013) [14] | 8 | Not reported | Not reported | Anti-tryptase and anti-chymase antibody | 20 (Sudden Cardiac Death), 10 (Opiate-related death) | Lung, Spleen |
Comment et al. (2014) [15] | 6 | 19–68 (45.2) | M (72) F (22) | Anti-tryptase antibody | 10 (hyperthermia), 10 (ketoacidosis), 10 (suicide), 18 (heroin overdose), 10 (sudden cardiac death), 10 (Acute myocardial infarct), 10 (car accident), 10 (arrhythmia) | Spleen |
Bonetti et al. (2014) [16] | 15 | 12–75 (55) | M (13) F (2) | Anti-tryptase antibody | 40 | Spleen |
Guo XJ et al. (2015) [17] | 15 | Not reported | M (10) F (5) | Anti- tryptase, anti-carboxypeptidase A, anti-mouse IgG-TRITC Antibody | 20 | Stomach, Jejunum, Lung, Larynx, Heart |
Radheshi et al. (2016) [18] | 1 | 55 | F | Anti-tryptase antibody | N/A | Spleen |
Takahashi et al. (2016) [19] | 1 | 60 | F | Anti-mast cell tryptase antibody | 1 | Lung |
Wang et al. (2020) [20] | 20 | 0–75 (34.1) | M | Anti-human mast cell tryptase antibody, rabbit anti-human IgE antibody | 52 | Glottis, Lung, intestinal tissues |
D’Errico (2020) [21] | 1 | 79 | M | Anti-tryptase antibody | N/A | Lung |
Esposito et al. (2021) [22] | 11 | 16–69 (47) | M (4) F (7) | Anti-tryptase monoclonal antibody | 7 (sudden cardiac death), 4 (car accident), | Glottis, Lung, Skin |
Tambuzzi et al. (2021) [23] | 1 | 30 | M | Anti-CD117 and anti-tryptase antibody | N/A | Glottis, Myocardiu, Lung |
Feng et al. (2021) [24] | 30 | 4–78 (45.23) | M (16) F (14) | Anti-FcεRIα and anti-tryptase antibody | 30 (sudden cardiac death, falling from a height, or traffic accident) | Lung |
References | Food | Drugs | Illicit Drugs | Hymenoptera | Contrast Agent | Other |
---|---|---|---|---|---|---|
Fineschi et al. (2001) [6] | - | - | Heroin | - | - | - |
Edston et al. (1999) [7] | - | - | - | - | - | Sudden infant death |
Perskvist et al. (2007) [8] | Food | Penicillin-V | - | Mites, bee sting | Radio-opaque dye | Pollen, pets, unknown |
Osawa et al. (2008) [9] | - | Nolport, Cefotiam hydrochloride | - | - | Ioxaglic acid | - |
Turillazzi et al. (2008) [10] | - | - | - | - | - | Latex |
Trani et al. (2008) [11] | - | Unasyn, Rocephin, Tazobac, Fidato | - | - | - | - |
Unkrig et al. (2010) [12] | Food (unknown) | - | - | - | - | - |
Luongo et al. (2011) [13] | - | Beta-lactam antibiotic, propolis | - | - | - | - |
Edston et al. (2013) [14] | - | - | Opiates | - | - | - |
Comment et al. (2014) [15] | - | - | - | - | Gadobutrol, iomeprol, iohexol | - |
Bonetti et al. (2014) [16] | - | Penicillin, cephalosporin | - | Insect stings | Radiocontrast, gadolinium | - |
Guo XJ et al. (2015) [17] | - | Penicillin, ceftriaxone, levofloxacina, lomefloxacina, ibuprofen | - | - | - | - |
Radheshi et al. (2016) [18] | - | Clarithromycin | - | - | - | - |
Takahashi et al. (2016) [19] | - | Ceftriaxone | - | - | - | - |
Wang et al. (2020) [20] | - | Drug | - | - | - | - |
D’Errico (2020) [21] | - | Ceftriaxone | - | - | - | - |
Esposito et al. (2021) [22] | Food | Medications | - | - | Contrast medium injected | Latex |
Tambuzzi et al. (2021) [23] | Peach | - | - | - | - | - |
Feng et al. (2021) [24] | - | Ceftriaxone, safflower, azitromicina, ambroxol hydrochloride, sulbactam, cefoperazone, midazolam, cefuroxime, ceftazidime pentahydrate, Sanqi Panax Notoginseng for Injection | - | - | - | - |
Type | Apten | no. |
---|---|---|
Food | Peach | 1 |
Unknown | 2 | |
Drugs | Penicillin | 6 |
Nolport | 1 | |
Unasyn | 1 | |
Cephalosporins | 20 | |
Propolis | 1 | |
Opiates | 1 | |
Penicillin or cephalosporins | 5 | |
Drug in general | 26 | |
Levofloxacin | 3 | |
Lomefloxacin | 5 | |
Ibuprofen | 1 | |
Clarithromycin | 1 | |
Safflower | 2 | |
Azithromycin | 1 | |
Ambroxol | 2 | |
Sulbactam and cefoperazone | 10 | |
Sanqi Panax Notoginseng for Injection | 1 | |
Midazolam | 1 | |
Illicit drugs | Heroin | 48 (not all due to anaphylaxis) |
Other | SIDS | 44 (not all due to anaphylaxis) |
Latex | 2 | |
Pollen | 1 | |
Pets | 1 | |
Unknown | 1 | |
Hymenoptera | Mites | 1 |
Bee sting | 1 | |
Insects | 4 | |
Contrast agent | Radio-opaque dye | 1 |
Ioxaglic acid | 1 | |
Gadobutrol | 1 | |
Iomeprol | 3 | |
Iohexol | 2 | |
Gadolinium or radiocontrast | 6 | |
Contrast medium injected | 3 |
References | Lung | Glottis/Laryngeal Wall | Myocardium | Spleen | Stomach, Jejunum Intestinal Tissues | Skin |
---|---|---|---|---|---|---|
Fineschi et al. (2001) [6] | Anti-tryptase antibodies used as a mast cell marker; they were found mostly in the lungs; occasionally tryptase-positive material was found outside but it is difficult to establish if the degranulation has taken place in vivo or during the processing of the tissue. | N/A | N/A | N/A | N/A | N/A |
Edston et al. (1999) [7] | The anti-tryptase antibodies are positive in the lung tissue in accordance with the fact that prone position (pathogenic factor of SIDS) induces hypoxia and consequently the release of mast cell mediators. It could be also associated with a post-mortem artifact. | N/A | N/A | N/A | N/A | N/A |
Perskvist et al. (2007) [8] | Anti-tryptase antibodies are positive in group-1 (anaphylactic death) lung sections in all the mast cell subsets at the site of bronchial smooth muscle and parenchymal tissues; group 2 (asthma associated death) also presents these patterns but with a smaller number of cells. The average number of eosinophil and mast cells is different between groups 1 and 2: 1:1 in the first one and 7:1 in the second one. | N/A | The amount of eosinophil and mast cells is higher only in group 1; in fact anaphylaxis is a systemic disorder while asthma is a local disorder. | N/A | N/A | N/A |
Osawa et al. (2008) [9] | The anti-tryptase antibodies are positive in mast cells in the vicinity of alveoli and capillaries. (Differences were not statistically significant in terms of the tryptase-positive cells; in contrast, differences were meaningful with respect to the chymase-positive and doubly positive cells). | N/A | N/A | N/A | N/A | N/A |
Turillazzi et al. (2008) [10] | Anti-tryptase anti-bodies in the bronchial walls and capillary septa, identifying pulmonary mast cells, and a great number of degranulated cells are identified with a halo of tryptase positiveness. | N/A | N/A | N/A | N/A | N/A |
Trani et al. (2008) [11] | N/A | N/A | N/A | Mast cell positivity in splenic sinuses so that it could be useful to consider the spleen as a shock organ where the trigger is initially pressed by the allergen to start IAD (immediate anaphylactic death) | N/A | N/A |
Unkrig et al. (2010) [12] | The antibodies are positive inside mast cells but also a vacuolar accumulation of anti-tryptase near mast cells is found and interpreted as a sign of degranulation; the typical patterns are starry sky-like and yard-like. | Throat mucosa mast cells (the same patterns of lungs). | N/A | N/A | Intestinal mucosa (the same patterns of lungs and throat). | N/A |
Luongo et al. (2011) [13] | N/A | Anti-tryptase antibodies are positive in mast cells in the laryngeal wall. | N/A | N/A | N/A | N/A |
Edston et al. (2013) [14] | The antibodies are positive in mast cells in the bronchial wall and the perivascular spaces (tryptase-positive mast cells are more numerous than chymase-positive ones). | N/A | N/A | Antibodies are positive in mast cells in the splenic red pulp (tryptase-positive mast cells are more numerous than chymase-positive ones). | N/A | N/A |
Comment et al. (2014) [15] | N/A | N/A | N/A | Anti-tryptase antibodies highlight the presence of degranulated mast cells in spleen samples. | N/A | N/A |
Bonetti et al. (2014) [16] | Anti-tryptase antibodies highlight mast cells’ degranulation in the interstitial space of the lungs. | N/A | N/A | Anti-tryptase antibodies show degranulated mast cells in spleen tissue. | N/A | N/A |
Guo XJ et al. (2015) [17] | The expression of tryptase is evident in the bronchial walls and in the small vessel walls in the lung. | Tryptase is expressed in the small vessel walls in the submucosa of the larynx. | Tryptase is evident in the periphery mesenchyme of the small vessels in the heart. | N/A | Tryptase expression is evident in the mucous layer, and less in the muscular layer of the stomach and jejunum. | N/A |
Radheshi et al. (2016) [18] | N/A | N/A | N/A | Anti-tryptase antibodies exhibit the characteristic degranulation of mast cells in spleen tissue. | N/A | N/A |
Takahashi et al. (2016) [19] | Anti-tryptase antibodies show mast cells with a starry-sky pattern in the lung. | N/A | N/A | N/A | N/A | N/A |
Wang et al. (2020) [20] | Anti-tryptase antibodies highlight a great number of mast cells mostly located around blood vessels and a few in pulmonary epithelial cells. | Anti-tryptase antibodies show mast cells in the laryngeal lamina propria around small blood vessels and cement glands. | N/A | N/A | Anti-tryptase antibodies are positive in the glands of the intestinal mucosa and in the connective tissue of the submucosa. | N/A |
D’Errico (2020) [21] | Anti-tryptase antibodies highlight a great number of degranulating mast cells with tryptase-positive material outside. | N/A | N/A | N/A | N/A | N/A |
Esposito et al. (2021) [22] | Anti-tryptase antibodies are found in the mast cells of the connective interstitium and bronchiolar structure. | The glottis shows an overexpression of anti-tryptase antibody at the vocal fold level. | N/A | N/A | N/A | Anti-tryptase antibodies highlight the presence of mast cells at the site of medication. |
Tambuzzi et al. (2021) [23] | Antibodies highlight cells with cytoplasm rich in granules; the typical patterns are starry sky-like and yard-like. | Cells with cytoplasm rich in granules were documented in the glottis; additionally, there is the presence of lung patterns. | The positivity in the myocardium presents the same pattern as in the lung and glottis. | N/A | N/A | N/A |
Feng et al. (2021) [24] | Anti-tryptase antibodies show mast cells, mainly located around bronchioles, bronchi, and blood vessels. | N/A | N/A | N/A | N/A | N/A |
References | Lung | Glottis/Laryngeal Wall | Myocardium | Spleen | Stomach, Jejunum Intestinal Tissues | Skin |
---|---|---|---|---|---|---|
Fineschi et al. (2001) [6] | N/A | N/A | N/A | N/A | N/A | N/A |
Edston et al. (1999) [7] | ||||||
Perskvist et al. (2007) [8] | Anti-chymase antibodies highlight the same patterns of the anti-tryptase ones in all the mast cell subsets at the site of bronchial smooth muscle and parenchymal tissues. | N/A | Anti-chymase antibodies highlight heart mast cells, according to the fact that anaphylaxis is a systemic disorder. | N/A | N/A | N/A |
Osawa et al. (2008) [9] | Pulmonary mast cells are in the vicinity of alveoli and capillaries (differences were not statistically significant in terms of the tryptase-positive cells; in contrast, differences were meaningful with respect to the chymase-positive and doubly positive cells). | N/A | N/A | N/A | N/A | N/A |
Turillazzi et al. (2008) [10] | N/A | N/A | N/A | N/A | N/A | N/A |
Trani et al. (2008) [11] | N/A | N/A | N/A | Mast cells have positivity in splenic sinuses so that it could be useful to consider the spleen as a shock organ where the trigger is initially pressed by the allergen to start IAD (immediate anaphylactic death) | N/A | N/A |
Unkrig et al. (2010) [12] | N/A | N/A | N/A | N/A | N/A | N/A |
Luongo et al. (2011) [13] | ||||||
Edston et al. (2013) [14] | The antibodies are positive in mast cells in the bronchial wall and the perivascular spaces (tryptase-positive mast cells are more numerous than chymase-positive ones). | N/A | N/A | Antibodies are positive in mast cells in the splenic red pulp (tryptase-positive mast cells are more numerous than chymase-positive ones). | N/A | N/A |
Comment et al. (2014) [15] | N/A | N/A | N/A | N/A | N/A | N/A |
Bonetti et al. (2014) [16] | N/A | N/A | N/A | N/A | N/A | N/A |
Guo XJ et al. (2015) [17] | N/A | N/A | N/A | N/A | N/A | N/A |
Radheshi et al. (2016) [18] | N/A | N/A | N/A | N/A | N/A | N/A |
Takahashi et al. (2016) [19] | N/A | N/A | N/A | N/A | N/A | N/A |
Wang et al. (2020) [20] | N/A | N/A | N/A | N/A | N/A | N/A |
D’Errico (2020) [21] | N/A | N/A | N/A | N/A | N/A | N/A |
Esposito et al. (2021) [22] | N/A | N/A | N/A | N/A | N/A | N/A |
Tambuzzi et al. (2021) [23] | N/A | N/A | N/A | N/A | N/A | N/A |
Feng et al. (2021) [24] | N/A | N/A | N/A | N/A | N/A | N/A |
References | Lung | Glottis/Laryngeal Wall | Myocardium | Spleen | Stomach, Jejunum Intestinal Tissues | Skin |
---|---|---|---|---|---|---|
Fineschi et al. (2001) [6] | N/A | N/A | N/A | N/A | N/A | N/A |
Edston et al. (1999) [7] | N/A | N/A | N/A | N/A | N/A | N/A |
Perskvist et al. (2007) [8] | N/A | N/A | N/A | N/A | N/A | N/A |
Osawa et al. (2008) [9] | N/A | N/A | N/A | N/A | N/A | N/A |
Turillazzi et al. (2008) [10] | N/A | N/A | N/A | N/A | N/A | N/A |
Trani et al. (2008) [11] | N/A | N/A | N/A | N/A | N/A | N/A |
Unkrig et al. (2010) [12] | The antibodies are positive inside mast cells but also a vacuolar accumulation of anti-tryptase near mast cells is found and interpreted as a sign of degranulation; the typical patterns are starry sky-like and yard-like. | Throat mucosa mast cells (the same patterns of lungs). | N/A | N/A | Intestinal mucosa (the same patterns of lungs and throat). | N/A |
Luongo et al. (2011) [13] | N/A | Anti-cd117 antibodies are positive in mast cells in the laryngeal wall; moreover, cells with dendritic morphology and small lymphocytes are positive. | N/A | N/A | N/A | N/A |
Edston et al. (2013) [14] | N/A | N/A | N/A | N/A | N/A | N/A |
Comment et al. (2014) [15] | N/A | N/A | N/A | N/A | N/A | N/A |
Bonetti et al. (2014) [16] | N/A | N/A | N/A | N/A | N/A | N/A |
Guo XJ et al. (2015) [17] | N/A | N/A | N/A | N/A | N/A | N/A |
Radheshi et al. (2016) [18] | N/A | N/A | N/A | N/A | N/A | N/A |
Takahashi et al. (2016) [19] | N/A | N/A | N/A | N/A | N/A | N/A |
Wang et al. (2020) [20] | N/A | N/A | N/A | N/A | N/A | N/A |
D’Errico (2020) [21] | N/A | N/A | N/A | N/A | N/A | N/A |
Esposito et al. (2021) [22] | N/A | N/A | N/A | N/A | N/A | N/A |
Tambuzzi et al. (2021) [23] | Antibodies highlight cells with cytoplasm rich in granules; the typical patterns are starry sky-like and yard-like. | Cells with cytoplasm rich in granules were documented in the glottis (right and left vocal cords) | The positivity in the myocardium presents the same pattern as that of the lung and glottis. | N/A | N/A | N/A |
Feng et al. (2021) [24] | N/A | N/A | N/A | N/A | N/A | N/A |
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Del Duca, F.; Manetti, A.C.; Maiese, A.; Napoletano, G.; Ghamlouch, A.; Pascale, N.; Giorgio, B.; Paola, F.; Russa, R.L. Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis. Medicina 2023, 59, 2184. https://doi.org/10.3390/medicina59122184
Del Duca F, Manetti AC, Maiese A, Napoletano G, Ghamlouch A, Pascale N, Giorgio B, Paola F, Russa RL. Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis. Medicina. 2023; 59(12):2184. https://doi.org/10.3390/medicina59122184
Chicago/Turabian StyleDel Duca, Fabio, Alice Chiara Manetti, Aniello Maiese, Gabriele Napoletano, Alessandro Ghamlouch, Natascha Pascale, Bolino Giorgio, Frati Paola, and Raffaele La Russa. 2023. "Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis" Medicina 59, no. 12: 2184. https://doi.org/10.3390/medicina59122184