Postmortem serum levels of total IgE

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

Singapore has been using mRNA vaccines developed by Pfizer-BioNTech and Moderna as part of the nation's COVID vaccination program since 30 December 2020. From 1 February 2021-30 June 2021, a total of 34 deaths that occurred within 72 h of the deceased receiving their COVID-19 vaccination were referred to the Forensic Medicine Division of the Health Sciences Authority of Singapore. Autopsies, histological sampling and ancillary investigations consisting of total tryptase level, Immunoglobulin E (IgE), and C-reactive Protein (CRP), were performed on 29 of these cases. Our study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died within 72 h after receiving the vaccination, in particular with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. Further studies may consider increasing the incident time frame from 72 h to seven days post-vaccination or longer to include any potential delayed presentation of adverse effects.

Significance of detecting postmortem serum IgE in frozen corpses for the diagnosis of anaphylaxis in forensic

The aim of this study was to detect the postmortem serum total IgE levels in frozen corpses and identify whether the death incident caused by an anaphylaxis in forensic medicine. Autopsy cases with pathological death (total, n = 106; 4-214 h postmortem) include cardiac disease (n = 15), pulmonary infection (n = 12), central nervous system disorder (n = 6), pulmonary emboliszn (n = 7), hapetic disease (n = 5), kidney disease (n = 6), enteric disease (n = 10), necrotizing pancreatitis (n = 7), diffuse peritonitis (n = 6), MODS (n = 6), toxicosis (n = 5:), anaphylactic shock (n = 7), bronchial asthma (n = 8) and other disease (n = 6) were examined. Results showed that there was no significant difference between serum IgE levels and ages, postmortem intervals (PMIs), gender as well as survival time. Serum IgE levels of deaths due to anaphylactic shock and bronchial asthma were higher than that of other groups. Forensic pathology examination results showed the main pathology changes of bronchial asthma were mucous congestion in bronchial lumen and eosinophils infiltration in bronchial mucosa. The main pathological features of anaphylactic shock were laryngeal edema and eosinophils infiltration in multiple organs (lung and spleen). This research proved that there was a great significance for IgE to infer whether the individual died due to an anaphylaxis even for a long PMI in frozen corpses. Furthermore, we can also preliminarily determine the type of allergic death combined with the examination of forensic pathology. These findings further verify the feasibility of postmortem serum IgE in the diagnosis of forensic causes of death and broaden the application scope of this marker.

Reliable Postmortem Molecular Diagnosis of Anaphylaxis: Co-localization of Mast Cell Degranulation and Immunoglobulin E in Allergic Throat Tissues

Anaphylaxis is a serious reaction that may cause death in half an hour without diagnostic characteristic in autopsies. Mast cell (MC) degranulation combined with immunoglobulin E (IgE) plays the key roles in anaphylaxis. Unavailability of serum and instability of measured serum in postmortem diagnoses sometimes limit the opinion of medical experts. Allergic tissues are more accessible than serum, and there is a little research on degranulated mast cells and IgE in different human tissues, whereas we hardly know whether the expression will keep stable over the increasing postmortem interval (PMI). In this research, we examined the mast cell counts and degranulation rates and gE contents in human throat, lung, and intestine tissues and preliminarily investigated the correlation of these markers with PMI in anaphylaxis-associated death. Allergic samples showed a significant increase in mast cell degranulation accompanied by an increase in IgE levels than the control group, but the expression was not significantly correlated with increasing PMI only in throat tissues. Elevated mast cell degranulation combined with increased IgE levels may be a reliable biomarker for forensic diagnosis of human tissues due to IgE-mediated allergic sudden death.

Histopathologic Analysis in Sudden Infant and Child Deaths: A Practical Approach

The forensic pathologist responsible for sudden unexpected death (SUD) investigation in the pediatric setting faces many challenges. It usually takes many years to obtain reasonable experience and exposure to the wide variety of diseases that may present as SUD in a pediatric context, and to appreciate the differences in the etiology and clinical context between the pediatric and adult SUD setting. In pediatric SUD, it is necessary to conduct a systematic, pediatric-focused autopsy investigation including extensive histopathological assessment and ancillary testing. Postmortem histologic findings in the context of SUD in the pediatric population are often subtle and distinctly different from those seen in the adult population. The pathologist must have an understanding of both developmental and pathological processes in order to correctly interpret the findings during a pediatric autopsy. A system-based, histopathology-focused review of common entities, normal variants, and incidental findings that can prove challenging will be discussed. For the forensic pathologist tasked with pediatric SUD autopsies, development of a strong collaborative relationship with a pediatric pathologist and/or neuropathologist to assist with histopathological analysis is strongly endorsed.