Fatal anaphylactic shock: A review of postmortem biomarkers and diagnostics

Anaphylactic deaths: A retrospective study of forensic autopsy cases from 2009 to 2019 in Shanghai, China

“…Nevertheless, the postmortem interval, sampling technique, and varied reference values may limit their usefulness, and non-specificity should be considered in some conditions. An increased specific IgE level in decedents who have been exposed to the allergen supports a diagnosis of fatal anaphylaxis [ 46 ]. Conversely, a lack of increased IgE does not rule out anaphylactic death [ 47 ].…”

“…Our results further illustrated the role of IgE in anaphylactic death. The quantification of infiltration and activation of mast cells and eosinophils by immunohistological technique is a promising field and needs to be further studied in the postmortem diagnosis of fatal anaphylaxis [ 46 ]. We believe that it is urgent to further explore the diagnostic biomarkers of anaphylactic death, which should be specific, cost-effective and less affected by postmortem interval.…”

Postmortem Biochemistry and Immunohistochemistry in Anaphylactic Death Due to Hymenoptera Sting: A Forensic Case Report

“…The case argumentation highlights that postmortem diagnosis of anaphylactic death is based on a combination of data about the event, medical history, gross and microscopic examination, and blood serum analyses. Particularly, even if tryptase analysis by biochemistry and immunohistochemistry and IgE dosage have limits in specificity and sensitivity, their integration with the other information is fundamental to performing a differential diagnosis and, thus, to assessing anaphylaxis [34]. Moreover, a prompt sampling, performed as soon as possible, is crucial to prevent the effect of postmortem phenomena (i.e., cell lysis) on tryptase [35].…”

Post COVID-19 vaccine deaths - Singapore’s early experience

“…Rare cases of elevated serum tryptase and/or serum IgE without signs of anaphylaxis at autopsy were noted. While elevated levels of serum tryptase and IgE with the accompanying clinical manifestations would be diagnostic of anaphylaxis, elevated serum tryptase and IgE levels in isolation are difficult to interpret in the post-mortem setting [49] . Edston concluded that it is possible to diagnose anaphylaxis with a high degree of certainty by quantifying eosinophil granulocytes and mast cells in the spleen in combination with tryptase measurements in serum [50] .…”

“…Raised serum tryptase concentrations have been observed in deaths due to coronary heart diseases, and also noted in other diseases such as end-stage renal failure, acute myelocytic leukemia and myelodysplastic syndromes. The post-mortem interval, hemolysis, and trauma may also affect the post-mortem tryptase concentration [49] , [51] , [52] . The increase in tryptase concentration in cases that have sustained trauma may account for the elevated tryptase concentrations in cases 7, 28, 29 and 33, as the first 3 cases were documented to have received aggressive cardiopulmonary resuscitation and case 33 sustained a traumatic head injury.…”