1
|
Li WX, Sun CH, Li ZD, Lin JY, Shao Y, Chen L, Li LL, Ye X, Shen YW. Anaphylactic deaths: A retrospective study of forensic autopsy cases from 2009 to 2019 in Shanghai, China. Heliyon 2024; 10:e28049. [PMID: 38515709 PMCID: PMC10955291 DOI: 10.1016/j.heliyon.2024.e28049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Anaphylaxis is a rare but well-known cause of sudden unexpected death, although data from forensic autopsies in anaphylactic deaths are limited. Herein, a retrospective study of a series of allergic deaths from 2009 through 2019 in Shanghai, China, was conducted to investigate the demographic, medical, and forensic pathological characteristics of fatal anaphylaxis to improve medicolegal understanding on anaphylactic death. Sixty-two autopsy cases of anaphylactic death were registered in this study. Males dominated the cases (74.2%) against females (25.8%), with an average age of 38.8 years. Medications (98.4%), particularly antibiotics (72.6%), were the most frequent cause of anaphylaxis, and 44 cases (71.0%) occurred in clinics administered illegally by unlicensed clinicians. The anaphylactic symptoms began within a few minutes to less than 1 h in 53 cases, with dyspnea (56.5%) and sudden shock (46.8%) being the most common clinical signs. Thirty cases (48.4%) of anaphylaxis resulted in death within 1 h. Laryngeal edema and multiple tissue eosinophil infiltration (85.5%) were the most prevalent autopsy findings, followed by pulmonary edema and congestion (24.2%), which were considered to be non-specific but suggestive. The comorbidities were mainly cardiovascular disease (33.9%), pneumonia (8.1%) and asthma (8.1%). Serum IgE were measured in 11 of 62 cases, ranging from 43.3 to 591 IU/ml, severed as a helpful marker. Therefore, we suggested a thorough analysis of allergen exposure, clinical history and autopsy findings is required for the diagnosis of anaphylactic death currently.
Collapse
Affiliation(s)
- Wen-xin Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Cheng-hui Sun
- Criminal Science and Technology Research Institute, Fengxian Branch of Shanghai Municipal Public Security Bureau, Shanghai, 201499, PR China
| | - Zheng-dong Li
- Shanghai Key laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, 200063, PR China
| | - Jun-yi Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Yu Shao
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Long Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Li-liang Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Xing Ye
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Yi-wen Shen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| |
Collapse
|
2
|
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 (KAUNAS, LITHUANIA) 2023; 59:2184. [PMID: 38138287 PMCID: PMC10744436 DOI: 10.3390/medicina59122184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.
Collapse
Affiliation(s)
- Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alice Chiara Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Natascha Pascale
- Department of Forensic Medicine, Hospital ‘San Carlo’, 85100 Potenza, Italy;
| | - Bolino Giorgio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Frati Paola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| |
Collapse
|
3
|
Feng C, Zhang C, Wang P, Wang X, You J, Zhang G, Yu H. Expression of FcεRIα and tryptase in human lung tissue during drug-induced anaphylactic death. Forensic Sci Med Pathol 2021; 17:547-552. [PMID: 34383238 DOI: 10.1007/s12024-021-00405-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 02/07/2023]
Abstract
The diagnosis of drug-induced anaphylactic death is an important component of forensic medicine. The purpose of this study was to explore the expression of FcεRIα and tryptase in human lung tissue during drug-induced anaphylactic death and its value for forensic medicine. The expression of FcεRIα and tryptase in lung tissues of the drug-induced anaphylactic death group (n = 30) and control group (who died due to sudden cardiac death, falling from a height, or traffic accidents, n = 30) was detected by immunohistochemistry and immunofluorescence staining. The difference in FcεRIα and tryptase expression in the lung tissue between the drug-induced anaphylactic death group and the control group was statistically significant (p < 0.05). The levels of FcεRIα and tryptase expression greatly increased in the lung tissue of the drug-induced anaphylactic death group, which may provide morphological evidence and a reference for the diagnosis of drug-induced anaphylactic death in forensic medicine.
Collapse
Affiliation(s)
- Chunmei Feng
- School of Forensic Medicine, China Medical University, Shenyang, 110122, P.R. China.,Department of Pathology, Mudanjiang Medical College, Mudanjiang, Heilongjiang, 157011, P.R. China
| | - Chaoxu Zhang
- Department of Hematology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Pengfei Wang
- School of Forensic Medicine, China Medical University, Shenyang, 110122, P.R. China
| | - Xiaolong Wang
- School of Forensic Medicine, China Medical University, Shenyang, 110122, P.R. China
| | - Jiabin You
- Economic and Technological Development Zone Branch of Shenyang Public Security Bureau, Shenyang, 110122, P.R. China
| | - Guohua Zhang
- School of Forensic Medicine, China Medical University, Shenyang, 110122, P.R. China.
| | - Hao Yu
- School of Forensic Medicine, China Medical University, Shenyang, 110122, P.R. China.
| |
Collapse
|
4
|
Heldring N, Kahn L, Zilg B. Fatal anaphylactic shock: A review of postmortem biomarkers and diagnostics. Forensic Sci Int 2021; 323:110814. [PMID: 33951572 DOI: 10.1016/j.forsciint.2021.110814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/21/2022]
Abstract
Diagnosing anaphylactic shock postmortem is challenging since differential diagnoses exist and the forensic pathologist often faces subtle findings and lacks relevant information which prevents reaching an opinion of certainty. This review provides an overview of the literature covering research and existing recommendations on the postmortem diagnosis of anaphylactic shock. In order to harmonize the approach and provide guidance for diagnosing deaths from anaphylactic shock in the six forensic centers in Sweden, a guidance protocol aligned with the notion of a holistic view in the approach was devised. Areas in need of further studies include both immunohistological and biochemical investigations to stratify quantitative approaches based on condition and anaphylactic trigger and to lay the ground for and possibly establish alternative matrices.
Collapse
Affiliation(s)
- Nina Heldring
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden.
| | - Lydia Kahn
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden
| | - Brita Zilg
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden
| |
Collapse
|
5
|
Lv Y, Fu J, Jia Q, Dong H, Han S, Li L, He L. Liquid Chromatography Tandem Mass Spectrometry Based Label-Free Quantification Method for Assessment of Allergen-Induced Anaphylactoid Reactions. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2020; 31:856-863. [PMID: 32125841 DOI: 10.1021/jasms.9b00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mast cells are essential in mediating inflammatory processes. When activated, mast cells can rapidly release characteristic granules and various mediators into the interstitium. Tryptase (TPS) and β-hexosaminidase (HEXB) are typical protease mediators stored in granules and released upon activation. They have been recognized as important biomarkers of anaphylaxis, and the released level is associated with the severity of allergic reactions. In this study, a sensitive, accurate, and selective liquid chromatography tandem mass spectrometry (LC-MS/MS) method for simultaneously quantifying the two biomarkers was developed and validated in LAD2 cell culture supernatant, and P14R was used as internal standard. Good linearity was observed in the range of 50-2500 ng/mL for TPS and 10-2000 ng/mL for HEXB both with R2 > 0.99. The matrix effect and recovery were both within acceptable limits. We quantified TPS and HEXB released from Laboratory of Allergic Disease 2 (LAD2) mast cells treated with several potential allergens, and the results demonstrate that the method can be used to investigate TPS and HEXB levels in LAD2 mast cell model during allergy research. We anticipate our approach to be a robust and sensitive assessment method for more biomarkers with similar kinetics characteristics and to be a major tool of allergic drug assessment or antiallergic drug development in research.
Collapse
Affiliation(s)
- Yanni Lv
- School of Pharmacy, Xi'an Jiaotong University, 76# Yanta West Road, Xi'an 710061, China
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, Wisconsin 53705, United States
| | - Jia Fu
- School of Pharmacy, Xi'an Jiaotong University, 76# Yanta West Road, Xi'an 710061, China
| | - Qianqian Jia
- School of Pharmacy, Xi'an Jiaotong University, 76# Yanta West Road, Xi'an 710061, China
| | - Hengtao Dong
- Shimadzu (China) Co., Ltd., 56# Jinye First Road, Xi'an 710000, China
| | - Shengli Han
- School of Pharmacy, Xi'an Jiaotong University, 76# Yanta West Road, Xi'an 710061, China
| | - Lingjun Li
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, Wisconsin 53705, United States
| | - Langchong He
- School of Pharmacy, Xi'an Jiaotong University, 76# Yanta West Road, Xi'an 710061, China
| |
Collapse
|
6
|
Ariza A, Torres MJ, Moreno-Aguilar C, Fernández-Santamaría R, Fernández TD. Early Biomarkers for Severe Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3829-3839. [DOI: 10.2174/1381612825666191107105440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023]
Abstract
Drug hypersensitivity reactions (DHRs) are typically classified into immediate and delayed reactions
based on the time interval between drug exposure and onset of symptoms. Clinical manifestations range from
mild to severe and life-threatening reactions. The most severe clinical entities are anaphylaxis and anaphylactic
shock for immediate reactions, and severe cutaneous adverse reactions such as Steven Johnson Syndrome and
Toxic Epidermal Necrolysis for delayed reactions. The diagnosis is complex and challenging, as drug provocation
tests and even skin tests can be very risky procedures, which makes them not recommended. Therefore, it is necessary
to search for useful early biomarkers to manage the diagnosis of these reactions. These biomarkers could
be useful to determine the clinical entity, but not to identify the culprit drug. Some of the currently available
biomarkers are few genetic associations of drug allergy with polymorphisms of human leukocyte antigen (HLA),
the detection of inflammatory and lipid mediators in serum, or the detection of cytokines, chemokines, and cytotoxic
markers in skin biopsies. In this literature review, it has been summarize the immunological mechanisms
involved in severe reactions, both immediate and delayed, and different early biomarkers: those currently used for
the diagnosis of these reactions as well as possible early biomarkers that could be useful with further studies to
standardize their clinical use.
Collapse
Affiliation(s)
- Adriana Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Maria J. Torres
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Carmen Moreno-Aguilar
- Immunology and Allergy Unit, IMIBICHospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Tahia D. Fernández
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| |
Collapse
|
7
|
Lee SH, Lee Y, Woo SD, Doo KE, Ha CY, Lee YH, Ye YM. Chlorpheniramine-induced anaphylaxis: Two case reports and a retrospective review of pharmacovigilance database. Medicine (Baltimore) 2019; 98:e18369. [PMID: 31852144 PMCID: PMC6922401 DOI: 10.1097/md.0000000000018369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Anaphylaxis is a serious allergic reaction which could be life-threatening. To date, it could be diagnosed by causality between clinical manifestations and triggers. But it is not always easy to find out the clue. Chlorpheniramine maleate (peniramin) is known to safe and it is an antihistamine commonly used to treat almost the whole allergic disease, including urticaria and allergic rhinitis. We recently experienced 2 cases of chlorpheniramine induced anaphylaxis. To document suspected cases of chlorpheniramine-induced adverse reactions, we analyzed a database spontaneously reported adverse drug reactions in the Ajou Regional Pharmacovigilance Center from 2011 to 2017. PATIENT CONCERNS Two female patients presented urticaria and abdominal pain right after chlorpheniramine injection. DIAGNOSES Both patients were diagnosed with symptoms. One patient confirmed by assistance with tryptase level and another one confirmed cross-reactivity by skin tests. INTERVENTIONS One patient was instructed to avoid future administration of chlorpheniramine. The other patient was advised not to take chlorpheniramine, and piperazine derivatives including cetirizine/levocetirizine, but piperidine derivatives such as fexofenadine, loratadine, and ebastine can be available. OUTCOMES The patients fully recovered after prompt treatment for anaphylaxis. After that, no recurrences were observed at the following. Among 54 patients with chlorpheniramine-induced adverse drug reactions from the Pharmacovigilance Center database, 17 (31.5%) were reported as anaphylaxis. LESSONS Physicians should be aware chlorpheniramine could be a cause for allergic reaction. In addition, we suggest that serum tryptase level, skin prick test, and intradermal test could be considered as a supplementary test for diagnosing chlorpheniramine anaphylaxis and cross-reactivity should also be considered.
Collapse
Affiliation(s)
- So-Hee Lee
- Department of Allergy and Clinical Immunology
| | | | | | - Ko-Eun Doo
- Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Chae-Yeon Ha
- Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Young-Hee Lee
- Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology
- Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| |
Collapse
|
8
|
Ahmad S, Wright KN, Sun X, Groban L, Ferrario CM. Mast cell peptidases (carboxypeptidase A and chymase)-mediated hydrolysis of human angiotensin-(1-12) substrate. Biochem Biophys Res Commun 2019; 518:651-656. [PMID: 31466718 DOI: 10.1016/j.bbrc.2019.08.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/17/2019] [Indexed: 02/07/2023]
Abstract
Angiotensin processing peptidases (carboxypeptidase A (CPA) and chymase) are stored in cardiac mast cell (MC) secretory granules in large quantity and are co-released into the extracellular environment after activation/degranulation. In the human heart, chymase is primarily responsible for angiotensin II (Ang II) generation from the alternate substrate angiotensin-(1-12) (Ang-(1-12)). We investigated the individual and combined hydrolytic specificity of CPA and chymase enzymes (1:1 and 1:⅓ ratio) in the processing of the human Ang-(1-12) (hAng-(1-12)) substrate. To determine the Km and Vmax, the CPA and recombinant human chymase (rhChymase) enzymes were incubated with increasing concentrations of hAng-(1-12) substrate (0-300 μM). We found that CPA alone sequentially metabolized hAng-(1-12) substrate into angiotensin-(1-9) (Ang-(1-9), 53%), Ang II (22%) and angiotensin-(1-7) (Ang-(1-7), 11%) during a 15 min incubation. In the presence of rhChymase alone, 125I-hAng-(1-12) was directly metabolized into Ang II (89%) and no further hydrolysis of Ang II was detected. In the presence of both CPA + rhChymase enzymes (1:1 or 1:⅓ ratio), the amount of Ang II formation from 125I-hAng-(1-12) within a 5 min incubation period were 68% or 65%, respectively. In the presence of both (CPA + rhChymase), small amounts of Ang-(1-9) and Ang-(1-7) were generated from 125I-hAng-(1-12). The Km and Vmax values were 150 ± 5 μM and 384 ± 23 nM/min/mg of CPA and 40 ± 9 μM and 116 ± 20 nM/min/mg of rhChymase. The catalytic efficiency (Vmax/Km ratio) was higher for rhChymase/hAng-(1-12) compared to CPA/hAng-(1-12). Compared to CPA, chymase has a much higher affinity to hydrolyze the hAng-(1-12) substrate directly into Ang II. In addition, Ang II and Ang-(1-7) are the end products of chymase and CPA, respectively. Overall, our findings suggest that the Ang II generation from hAng-(1-12) is primarily mediated by chymase rather than CPA.
Collapse
Affiliation(s)
- Sarfaraz Ahmad
- General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Kendra N Wright
- General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Xuming Sun
- Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Leanne Groban
- Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA; Internal Medicine/Molecular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Carlos M Ferrario
- General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| |
Collapse
|
9
|
Sun KJ, He JT, Huang HY, Xue Y, Xie XL, Wang Q. Diagnostic role of serum tryptase in anaphylactic deaths in forensic medicine: a systematic review and meta-analysis. Forensic Sci Med Pathol 2018; 14:209-215. [PMID: 29679215 DOI: 10.1007/s12024-018-9980-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 12/28/2022]
Abstract
Postmortem diagnosis of sudden death due to anaphylaxis can be very difficult due to the non-specific pathological findings in forensic practice. Postmortem serum tryptase has been used as an indicator of possible ante-mortem anaphylaxis. Though many previous studies have been conducted to explore the diagnostic significance of serum tryptase for lethal anaphylaxis, inconsistent results were documented. In this study, we made a retrospective study and presented a systematic review and meta-analysis that aims to summarize the diagnostic significance of postmortem serum tryptase in the deceased with and without anaphylactic shock and to calculate a cutoff value for future reference in the identification of deaths due to anaphylactic shock. A complete literature search in the PubMed, Cochrane Library, CNKI and Embase databases (published prior to March 1st, 2017) was performed. The quality of the eligible literature was evaluated according to the Newcastle-Ottawa Quality Assessment Scale (NOS), and the relevant data was extracted. The procedure of meta-analysis was performed by RevMan 5.3 software. Subgroup analysis was performed according to different causes of death. A total of nine studies with 296 patients were identified. The NOS of each included study was equal to 7. The results indicated that high concentrations of tryptase were significantly associated with anaphylactic shock when compared to the other causes of death. The weighted mean difference (WMD) was 29.53 (95% CI = 7.58-51.47, p = 0.008). Similar results were detected in the subgroup analysis when compared to deaths due to cardiovascular disease (CVD). However, no obvious elevation of tryptase in decedents with CVD compared to the other cause of death was observed (WMD = 4.42, 95% CI = -0.94-9.79). We concluded that high serum tryptase is a promising diagnostic biomarker for deaths due to anaphylactic shock, especially when it is higher than 30.4 μg/L.
Collapse
Affiliation(s)
- Kai-Jian Sun
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Jie-Tao He
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Hong-Yan Huang
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Ye Xue
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Xiao-Li Xie
- Department of Toxicology, School of Public Health and Tropical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China.
| | - Qi Wang
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China.
| |
Collapse
|
10
|
Kounis NG, Koniari I, Soufras G, Koutsogiannis N, Hahalis G. Specific IgE levels in pericardial and cerebrospinal fluids in forensic casework: The presence of additional molecules for sudden cardiac death diagnosis. Forensic Sci Int 2017; 282:79. [PMID: 29172173 DOI: 10.1016/j.forsciint.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece.
| | - Ioanna Koniari
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece
| | - George Soufras
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece
| | - Nikolaos Koutsogiannis
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece
| | - George Hahalis
- Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece
| |
Collapse
|
11
|
Muraro A, Lemanske RF, Castells M, Torres MJ, Khan D, Simon HU, Bindslev-Jensen C, Burks W, Poulsen LK, Sampson HA, Worm M, Nadeau KC. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017; 72:1006-1021. [PMID: 28122115 DOI: 10.1111/all.13132] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/30/2022]
Abstract
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.
Collapse
Affiliation(s)
- A. Muraro
- Food Allergy Referral Centre Veneto Region; Department of Women and Child Health; Padua General University Hospital; Padua Italy
| | - R. F. Lemanske
- Department of Pediatrics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - M. Castells
- Drug Hypersensitivity and Desensitization Center; Brigham & Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - D. Khan
- Division of Allergy & Immunology; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - W. Burks
- Department of Pediatrics; University of North Carolina; Chapel Hill NC USA
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte Hospital; Copenhagen Denmark
| | - H. A. Sampson
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Worm
- Klinik für Dermatologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. C. Nadeau
- Department of Medicine; Stanford University School of Medicine; Stanford CA USA
- Sean N. Parker Center for Allergy and Asthma Research; Stanford University School of Medicine; Stanford CA USA
| |
Collapse
|
12
|
Lavergne SN. In Vitro Research Tools in the Field of Human Immediate Drug Hypersensitivity and Their Present Use in Small Animal Veterinary Medicine. Vet Sci 2016; 4:E1. [PMID: 29056660 PMCID: PMC5606612 DOI: 10.3390/vetsci4010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 12/18/2022] Open
Abstract
Drug hypersensitivity reactions (DHR) are immune-mediated idiosyncratic adverse drug events. Type I DHR are often referred to as "immediate" and involve B lymphocyte-secreted IgE that bind to the membrane of basophils and mast cells, inducing their degranulation. This review presents various in vitro tests that were developed in the field of human type I HS and implemented as clinical diagnostic tools in human cases of immediate DHR. The respective strengths and weaknesses of each test will be discussed in parallel of validation data such as specificity and sensitivity whenever available. Some of them have also been used as diagnostic tools in veterinary medicine, but not in cases of immediate DHR. Most of these diagnostic tools can be categorized into humoral and cellular tests. The former tests measure serum concentrations of factors, such as histamine, tryptase, and drug-specific IgE. The latter assays quantify markers of drug-induced basophil activation or drug-specific lymphocyte proliferation. Pharmacogenetic markers have also been investigated in immediate DHR, but not as extensively as in non-immediate ones. Throughout, practical aspects and limitations of the tests, as well as sensitivity and specificity parameters, will be presented. In addition, the experience of veterinary medicine with these diagnostic tools will be summarized. However, to date, none of them has ever been reported in a veterinary case of type I DHR.
Collapse
Affiliation(s)
- Sidonie N. Lavergne
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois-Urbana-Champaign, 2001 South Lincoln Av, Urbana, IL 61802, USA.
| |
Collapse
|
13
|
Busardò FP, Marinelli E, Zaami S. Is the diagnosis of anaphylaxis reliable in forensics? The role of β-tryptase and its correct interpretation. Leg Med (Tokyo) 2016; 23:86-88. [PMID: 27890110 DOI: 10.1016/j.legalmed.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/14/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy.
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| |
Collapse
|