Postmortem diagnosis of fatal anaphylaxis during intravenous administration of therapeutic and diagnostic agents: Evaluation of clinical laboratory parameters and immunohistochemistry in three cases

Suicide of a man with known allergy to fish protein by ingesting tinned fish

“…In our case, a significantly elevated total IgE level was found in the blood of the deceased, which was attributable to the allergic reaction. The same applied to the markedly elevated tryptase concentration [7]. Although Edston and Van Hage-Hamsten [2] found elevated heart blood tryptase levels in cases such as traumatic deaths, deaths after heroin-injection and unexplained deaths, in the present case the elevated tryptase level seems to be part of an anaphylactic reaction.…”

Postmortem chemistry update part II

“…Tryptase is more stable, has a longer half-life and can be detected from a few minutes up to several hours after mast cell degranulation [99,100]. Analyses of tryptase in postmortem serum samples of suspected anaphylaxis and anaphylactoid reactions have consistently shown elevated values [99][100][101][102][103][104][105][106][107][108][109][110][111][112]. However, increased tryptase levels have also been demonstrated in other situations, including sudden death infant syndrome, acute death after heroin injection, atherosclerotic cardiovascular disease, and traumatic death [100,111,[113][114][115][116][117][118][119][120][121][122].…”

Forensic Investigation in Anaphylactic Deaths

“…So the N-methylhistamine, that is a product of histamine degradation and is stable in the urine, but in the cases of anaphylactic death the time is too short to find it into the urine (Sthephan et al 1990;Edston et al, 2005Edston et al, , 2007. Among the other possible tests we remember the serum titration of a mastcell-specific chymase (Nishio et al, 2005;Osawa et al 2008), that is a serum protein mainly kept into the mastcell granules. It's important to note that the positivity to total IgE or of the serum tryptase cannot be considered , by the forensic profile, as a sure indication of a death by anaphylaxis because the positivity of one or both the markers has been found also in other pathologies (Randall et al, 1995;Horn et al, 2004) such as traumatic death or the sudden infant death syndrome (Buckley et al, 2001;Edston et al, 1999;D'Errico et al, 2008;Holgate et al, 1994;Nishio & Suzuki, 2004;Schwartz, 2001) but must be integrated with the results of other investigations that must be done in every case of death.…”