Allergic reactions following contrast material administration: nomenclature, classification, and mechanisms

Palmière, Cristian; Comment, Lionel; Mangin, Patrice

doi:10.1007/s00414-013-0912-x

Cited by 20 publications

(20 citation statements)

References 66 publications

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“…While the role of mast cells in human anaphylaxis is rather definite, issues such as the identification of the chemotactic factors that attract eosinophils in the spleen and the major signaling mechanism(s) for eosinophil activation remain poorly understood. Activated mast cells release numerous effector molecules, some of which could act as eosinophil chemotactic factors and consequently be responsible for eosinophil accumulation in the spleen (26-30). …”

Section: Discussionmentioning

confidence: 99%

“…Additionally, macroscopic and microscopic findings may be unspecific or absent. Furthermore, factors consistent with the hypothesis of fatal anaphylaxis include an immediately preceding challenge with an allergen known to cause reactions, clinical features consistent with or suggesting anaphylaxis, a previous history of reactions to similar or cross-reactive allergens, specific IgE antibodies to the allergen suspected of causing the reaction as well as measurable products of mast cell activation (26,43-45). …”

Section: Discussionmentioning

confidence: 99%

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Vaccination and anaphylaxis: a forensic perspective

2017

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AimTo review the available literature pertaining to fatalities following vaccine administration and, in particular, cases of vaccine-related fatal anaphylaxis.MethodThe MEDLINE database was systematically searched up to March 2016 to identify all relevant articles pertaining to fatal cases of anaphylaxis following vaccine administration.ResultsSix papers pertaining to fatal anaphylaxis following vaccination were found relevant. Mast cell tryptase and total IgE concentration was assessed exclusively in one case. Laryngeal edema was not detected in any of these cases, whereas eosinophil or mast cell infiltration was observed in lymphoid organs. In one case, immunohistochemical investigations using anti-tryptase antibodies allowed pulmonary mast cells and degranulating mast cells with tryptase-positive material outside to be identified.ConclusionIn any suspected IgE-mediated fatal anaphylactic cases, biochemical investigations should be systematically performed for forensic purposes. Splenic tissue should be routinely sampled for immunohistochemical investigations in all suspected anaphylaxis-related deaths and mast cell/eosinophil infiltrations should be systematically sought out in the spleen, myocardium, and coronary artery wall. The hypothesis of fatal anaphylaxis following vaccination should be formulated exclusively when circumstantial data, available medical records, laboratory investigations, and autopsy or histology findings converge in a consistent pattern. The reasonable exclusion of alternative causes of death after all postmortem investigations is also imperative in order to establish or rule out a cause-and-effect relationship between vaccine administration and any presumptive temporarily-related death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vaccination and anaphylaxis: a forensic perspective

2017

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“…Postmortem serum mast cell tryptase and total IgE levels were increased in all cases and ranged from 51 to 979 ng/ml and from 61 to 225 kU/l, respectively. Reference values were chosen according to clinical and forensic literature [6]. Postmortem serum specific IgE, postmortem serum histamine, postmortem serum chymase and urine N-methyl-histamine were not determined due to antemortem biological sample unavailability, prolonged postmortem interval or insufficient quantities of postmortem serum after the levels of mast cell tryptase and total IgE had been established.…”

Section: Resultsmentioning

confidence: 99%

“…Most of these are generally mild and self-limiting. Nonetheless, fatal reactions may occasionally be observed, with some of these incidences falling under the purview of the inquiring authorities and forensic pathologists due to their in-hospital occurrences [1,2,3,4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

Risk Factors in Fatal Cases of Anaphylaxis due to Contrast Media: A Forensic Evaluation

Palmière

Bonetti

2014

Int Arch Allergy Immunol

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Background: Fatalities following contrast medium exposure are extremely rare in clinical routine, though they may occur as an exception. Some may fall under the purview of the inquiring authorities and forensic pathologists due to their in-hospital occurrence. The purpose of this study was to assess the risk factors for anaphylaxis due to contrast medium administration that can be identified in fatal cases. Methods: Fatalities occurred during the course of clinical investigations with contrast media described in the literature and fatal reactions to contrast agents that had undergone forensic investigations in our medicolegal center were reviewed with respect to patient characteristics, administered contrast medium, performed biochemical investigations and potential risk factors identified based on clinical history and medical records. Results: Biochemical investigations into the fatal cases examined in our facility revealed increased mast cell tryptase, total IgE and activated mast cells in all subjects. Data obtained from the literature and our own investigations indicated that in only a minority of the fatal cases had there been previous exposure to contrast compounds, while most cases of severe anaphylaxis involved patients who apparently reacted on initial exposure. Conclusions: Most fatal cases failed to present any identifiable predisposing conditions out of those traditionally considered as risk factors for an anaphylactic reaction to contrast compounds in the medical histories of the patients. Comprehensive clinical histories and thorough reviews of medical data, along with exhaustive forensic investigations, provide information that is relevant in order to better appreciate the interwoven relationships linking all factors potentially involved in the pathogenesis of fatal anaphylaxis to contrast media.

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“…The reaction is rapid in onset and results from the sudden, systemic release of mediators from mast cells and basophils [1][2][3]. Triggers may include food, stinging insect venoms, drugs, biological agents, radiocontrast media, latex or unknown causes [1].…”

Section: Introductionmentioning

confidence: 98%

A case of suicide by self-injection of adrenaline

Palmière

Bévalot

Malicier³

et al. 2015

Forensic Sci Med Pathol

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Adrenaline (epinephrine) auto-injectors provide life-saving pre-hospital treatment for individuals experiencing anaphylaxis in a community setting. Errors in handling adrenaline auto-injectors, particularly by children and healthcare professionals, have been reported. Reports of adrenaline overdoses are limited in the medical literature. In most of these cases, accidental adrenaline administration results from medical error. Exogenous administration of catecholamine is responsible for cardiovascular and metabolic responses, which may cause supraventricular tachycardia, ventricular dysrhythmias and myocardial ischemia. The authors present a unique autopsy case involving a 34 year-old woman who intentionally self-injected adrenaline using an adrenaline auto-injector as part of a suicide plan. Catecholamines and metanephrines were measured in peripheral and cardiac blood as well as urine and vitreous humor. Based on the results of all postmortem investigations, the cause of death was determined to be cardiac dysrhythmia and cardiac arrest following adrenaline self-injection.

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Allergic reactions following contrast material administration: nomenclature, classification, and mechanisms

Cited by 20 publications

References 66 publications

Vaccination and anaphylaxis: a forensic perspective

Vaccination and anaphylaxis: a forensic perspective

Risk Factors in Fatal Cases of Anaphylaxis due to Contrast Media: A Forensic Evaluation

A case of suicide by self-injection of adrenaline

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