Medicolegal Implications of Biphasic Anaphylaxis

Broi, Ugo Da; Moreschi, Carlo; Marega, Giulia; Tse, Rexson; Garland, Jack; Ondruschka, Benjamin; Palmière, Cristian

doi:10.1097/paf.0000000000000621

Cited by 4 publications

(9 citation statements)

References 100 publications

(1,012 reference statements)

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“…The median interval of symptom onset in an early assessment of cases for Corminaty was 13 min (range = 2–150 min), with 71% within the recommended general 15-min observation period after vaccination and 86% within 30 min [ 14 ]), which is the recommended extended observation period for individuals at greater risk for allergic reactions. However, the rare possibility of biphasic anaphylaxis has been described [ 16 ], also in the case of vaccination with Corminaty [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

et al. 2021

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Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.

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Section: Discussionmentioning

confidence: 99%

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

et al. 2021

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“…4 Progression and severity of a significant reaction is unpredictable; therefore, treatment should be initiated immediately for multisystem signs and symptoms. 25 A biphasic reaction, a secondary or late-phase anaphylactic reaction, may occur several hours after the complete resolution of the initial reaction. Biphasic reactions can develop 4 to 12 hours after the initial reaction and last longer than 70 hours.…”

Section: Anaphylaxismentioning

confidence: 99%

“…If any signs or symptoms in the initial anaphylactic reaction return, they are usually first respiratory and GI, then cardiovascular. 25 Individuals with a history of anaphylaxis must be educated regarding this potential secondary reaction and be advised When to seek emergency care 20 Sudden onset of:…”

Section: Anaphylaxismentioning

confidence: 99%

“…Therefore, it is imperative to seek immediate emergency care if an epinephrine autoinjector is utilized 19 , additional doses of epinephrine may be necessary due to the unpredictable nature of anaphylaxis and the risk of a biphasic reaction. 22,25 Medications that may be given as adjunctive therapies to epinephrine to treat anaphylaxis include H1 antihistamines (such as diphenhydramine), H2 antihistamines (such as famotdine), bronchodilators (such as albuterol), and glucocorticoids (such as methylprednisolone). None of these medications should be used as initial treatment or as monotherapy for anaphylaxis, as they do not relieve upper or lower respiratory tract obstruction, hypotension, or shock and are not lifesaving.…”

Section: Treatmentmentioning

confidence: 99%

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Food allergies

Mello,

Spencer,

Day

et al. 2024

Nursing

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“…The treatment of anaphylaxis of pregnant patients in acute care settings is basically the same as that in non-pregnant ones and it is not currently guided by biomarkers. Moreover, there are no anaphylaxis biomarkers to help identify the onset of biphasic anaphylaxis in clinical settings [ 143 ]. Pregnant patients with anaphylaxis may require emergency cesarean delivery to avoid fetal hypoxemia and prevent severe fetus damage, but currently, there are no validated molecular biomarkers for this indication [ 13 ].…”

Section: Management Of Anaphylaxismentioning

confidence: 99%

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Simionescu

Stănescu

Popescu

2021

Life

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Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.

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Medicolegal Implications of Biphasic Anaphylaxis

Cited by 4 publications

References 100 publications

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

Food allergies

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

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