Vaccination and anaphylaxis: a forensic perspective

Abstract

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.

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

“…In contrast, the forensic literature on fatal anaphylaxis following vaccination is surprisingly scarce. In a recent review, Palmiere et al [ 46 ] found six papers reporting cases of presumptively vaccine-related fatal anaphylaxis. Due to the limitations of five of these six papers, i.e., immunohistochemical, toxicological, or biochemical examinations being either not performed or not reported, they concluded that the diagnosis of vaccine-related fatal anaphylaxis remained hypothetical.…”

“…Histology may show edema of the upper airways with eosinophilic infiltration, as well as eosinophilic accumulation and shock signs of organs in general [ 12 , 22 ]. Histological and immunohistochemical examinations of splenic tissue may reveal eosinophil and activated mast cell accumulation in splenic red pulp [ 46 ]. For mast cell detection, Giemsa staining is used as well as immunostaining with anti-CD117, anti-tryptase, or anti-chymase antibodies [ 15 , 22 ].…”

“…For mast cell detection, Giemsa staining is used as well as immunostaining with anti-CD117, anti-tryptase, or anti-chymase antibodies [ 15 , 22 ]. In the myocardium and coronary arteries, adventitial eosinophils and mast cells may be a potential indication of allergic coronary artery spasm [ 33 , 46 ]. Postmortem biochemistry is recommended from peripheral blood, with sampling as soon as possible by aspiration from a clamped femoral or external iliac vein [ 26 ].…”

Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations

“…All four described pathophysiologic pathways can lead to allergic reactions, namely, mast cell activation and degranulation as IgE/antigen through cross-linking of FcεRI on mast cells, further resulting in complement system induction, activation of MRGPRX2 and overstimulation of T cells and monocytes/macrophages releasing cytokines. Indeed, atopic individuals who have a genetic predisposition to produce significant amounts of antibodies when simultaneously exposed to several allergens can have more symptoms than mono-sensitized individuals [ 50 ]. Furthermore, IgE antibodies with different specificities can have additive effects, and small, even sub-threshold IgE numbers can trigger the inflammatory cells to release their mediators and induce allergic reactions.…”

Common Vaccine Myths

“…Vaccines contain multiple compounds and any of the ingredients may be responsible for triggering the rare allergic reaction. For example, the egg products contained in some vaccine formulations may elicit an allergic reaction that has nothing to do with the antigen itself (Palmiere et al 2017).…”