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Zhang J, Liu Q, Gu F, Li Y, Chen H, Liu M, Zhou Y, Liu H, Wei X, Liu G. In vivo evaluations of Lactobacillus-fermented Eucheuma spinosum polysaccharides on alleviating food allergy activity. Food Funct 2024; 15:5895-5907. [PMID: 38727519 DOI: 10.1039/d4fo00991f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
In order to explore the in vivo anti-food allergy activity of Lactobacillus sakei subsp. sakei-fermented Eucheuma spinosum polysaccharides F1-ESP-3, an ovalbumin (OVA)-induced food allergy mouse model was established by ascites immunization and gavage. The weight, temperature, incidence of diarrhea, levels of allergic mediators and inflammatory factors in the serum of mice were analyzed. We analyzed the differentiation of mouse spleen lymphocytes and the proportion of sensitized mast cells by flow cytometry. The intestinal barrier status of mice was analyzed by intestinal pathological tissue sections and microbiota sequencing. The results showed that F1-ESP-3 could alleviate the food allergy symptoms of mice, such as hypothermia and loose stool; levels of OVA-specific immunoglobulin E, mast cell protease and histamine in the serum of sensitized mice and the proportion of dendritic cells and mast cells in mouse spleen were significantly reduced; in addition, F1-ESP-3 may protect the intestinal barrier and further improve the intestinal microenvironment of food-allergic mice by regulating the abundance of Bacteroidetes and Firmicutes. F1-ESP-3 can further improve the intestinal microenvironment of food-allergic mice by upregulating the levels of Lachnospiraceae, and may affect the signal pathways such as NOD-like receptor, MAPK, I kappa B and antigen processing and presentation.
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Affiliation(s)
- Jun Zhang
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, Fujian, China
| | - Qingmei Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Fudie Gu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Yan Li
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Huiying Chen
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Meng Liu
- College of Marine Biology, Xiamen Ocean Vocational College, Xiamen 361100, Fujian, China
| | - Yu Zhou
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Hong Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
| | - Xiaofeng Wei
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, Fujian, China
| | - Guangming Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, 361021, Fujian, China.
- College of Marine Biology, Xiamen Ocean Vocational College, Xiamen 361100, Fujian, China
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Cianci V, Pitrone C, Sapienza D, Meduri A, Ieni A, Gualniera P, Asmundo A, Mondello C. Fatal Outcome Due to Kounis Syndrome Following Fluorescein Retinal Angiography: A Case Report. Diagnostics (Basel) 2024; 14:1092. [PMID: 38893621 PMCID: PMC11171507 DOI: 10.3390/diagnostics14111092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Kounis Syndrome (KS) is a clinical entity triggered by allergic or hypersensitivity reactions capable of inducing acute coronary events. Several causes can induce KS, including drugs and insect stings. Here, a rare case of post mortem assessment of fatal KS related to fluorescein retinal angiography has been reported. An 80-year-old man in follow-up for a retinal vein thrombosis underwent a retinal fluoroangiography. Approximately 30 min later, the patient complained of sweating and dizziness, and suddenly lost consciousness due to a cardiac arrest. Despite the immediate cardiopulmonary resuscitation, he died. The autopsy revealed foamy yellowish edema in the respiratory tract and coronary atherosclerosis with eccentric plaques partially obstructing the lumen. The routine histology highlighted lung emphysema and myocyte break-up with foci of contraction band necrosis at the myocardial tissue. Biochemistry showed increased serum tryptase, troponin, and p-BNP. Activated and degranulated (tryptase) mast cells were detected, using immunohistochemistry, in the larynx, lungs, spleen, and heart. Acute myocardial ischemia due to allergic coronary vasospasm related to fluorescein hypersensitivity has been assessed as cause of death. KS-related deaths are considered rare events, and the post mortem assessment of KS quite difficult. The integration of several investigations (gross and microscopic examination, biochemistry, immunohistochemistry) can provide useful findings to support the diagnosis, helping to reduce the unrecognized cases as much as possible.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
| | - Claudia Pitrone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
| | - Alessandro Meduri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Ophthalmology, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy;
| | - Antonio Ieni
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy;
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (C.P.); (D.S.); (P.G.); (C.M.)
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Li WX, Sun CH, Li ZD, Lin JY, Shao Y, Chen L, Li LL, Ye X, Shen YW. Anaphylactic deaths: A retrospective study of forensic autopsy cases from 2009 to 2019 in Shanghai, China. Heliyon 2024; 10:e28049. [PMID: 38515709 PMCID: PMC10955291 DOI: 10.1016/j.heliyon.2024.e28049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Anaphylaxis is a rare but well-known cause of sudden unexpected death, although data from forensic autopsies in anaphylactic deaths are limited. Herein, a retrospective study of a series of allergic deaths from 2009 through 2019 in Shanghai, China, was conducted to investigate the demographic, medical, and forensic pathological characteristics of fatal anaphylaxis to improve medicolegal understanding on anaphylactic death. Sixty-two autopsy cases of anaphylactic death were registered in this study. Males dominated the cases (74.2%) against females (25.8%), with an average age of 38.8 years. Medications (98.4%), particularly antibiotics (72.6%), were the most frequent cause of anaphylaxis, and 44 cases (71.0%) occurred in clinics administered illegally by unlicensed clinicians. The anaphylactic symptoms began within a few minutes to less than 1 h in 53 cases, with dyspnea (56.5%) and sudden shock (46.8%) being the most common clinical signs. Thirty cases (48.4%) of anaphylaxis resulted in death within 1 h. Laryngeal edema and multiple tissue eosinophil infiltration (85.5%) were the most prevalent autopsy findings, followed by pulmonary edema and congestion (24.2%), which were considered to be non-specific but suggestive. The comorbidities were mainly cardiovascular disease (33.9%), pneumonia (8.1%) and asthma (8.1%). Serum IgE were measured in 11 of 62 cases, ranging from 43.3 to 591 IU/ml, severed as a helpful marker. Therefore, we suggested a thorough analysis of allergen exposure, clinical history and autopsy findings is required for the diagnosis of anaphylactic death currently.
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Affiliation(s)
- Wen-xin Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Cheng-hui Sun
- Criminal Science and Technology Research Institute, Fengxian Branch of Shanghai Municipal Public Security Bureau, Shanghai, 201499, PR China
| | - Zheng-dong Li
- Shanghai Key laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, 200063, PR China
| | - Jun-yi Lin
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Yu Shao
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Long Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Li-liang Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Xing Ye
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
| | - Yi-wen Shen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, PR China
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Forzese E, Pitrone C, Cianci V, Sapienza D, Ieni A, Tornese L, Cianci A, Gualniera P, Asmundo A, Mondello C. An Insight into Kounis Syndrome: Bridging Clinical Knowledge with Forensic Perspectives. Life (Basel) 2024; 14:91. [PMID: 38255706 PMCID: PMC10817466 DOI: 10.3390/life14010091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Kounis syndrome (KS) is an acute coronary syndrome triggered by allergic or hypersensitivity reactions. Incidence rates vary, with studies reporting 19.4 per 100.000 among all admissions and 3.4% among allergy patients. This review explores the expanding understanding of KS, encompassing various manifestations, and focusing on both clinical data and forensic findings useful in performing a diagnosis. The pathophysiology of this syndrome involves a complex interplay between allergic reactions and the cardiovascular system. Mast cell activation, histamine release, leukotrienes, cytokines, and platelet activation can contribute to coronary events. Three types of classification systems (allergic angina, allergic myocardial infarction, allergic stent thrombosis) aid in categorizing presentations. The diagnosis of KS relies on clinical presentation, laboratory findings, and imaging. Postmortem assessment of KS is based on the integration of circumstantial data, autopsy, and histological findings. Biochemical and immunohistochemical analyses also contribute to postmortem diagnosis. In conclusion, a combined, multidisciplinary approach should be used to ease the diagnostic process, which is crucial for forensic practitioners in confirming KS occurrence.
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Affiliation(s)
- Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Claudia Pitrone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy;
| | - Lorenzo Tornese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (E.F.); (C.P.); (D.S.); (L.T.); (P.G.); (C.M.)
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Del Duca F, Manetti AC, Maiese A, Napoletano G, Ghamlouch A, Pascale N, Giorgio B, Paola F, Russa RL. Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2184. [PMID: 38138287 PMCID: PMC10744436 DOI: 10.3390/medicina59122184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.
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Affiliation(s)
- Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alice Chiara Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Natascha Pascale
- Department of Forensic Medicine, Hospital ‘San Carlo’, 85100 Potenza, Italy;
| | - Bolino Giorgio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Frati Paola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Mondello C, Baldino G, Cianci V, Forzese E, Asmundo A, Ieni A, Ventura Spagnolo E. Postmortem Biochemistry and Immunohistochemistry in Anaphylactic Death Due to Hymenoptera Sting: A Forensic Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095640. [PMID: 37174160 PMCID: PMC10177871 DOI: 10.3390/ijerph20095640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Postmortem assessment of anaphylactic death is a challenge for forensic pathologists. One of the most frequent elicitors of anaphylaxis is insect venom. Here, a case of anaphylactic death due to Hymenoptera stings is reported to highlight the contribution of postmortem biochemistry and immunohistochemistry in assessing the cause of death. CASE REPORT A 59-year-old Caucasian man working on his farm was presumably stung by a bee and died. He had a history of previous sensitization to insect venom. The autopsy revealed no signs of insect puncture, mild edema of the larynx, and foamy edema in the bronchial tree and lungs. Routine histology showed endo-alveolar edema and hemorrhage, bronchospasm, and scattered bronchial obstruction due to mucus hyperproduction. Biochemical analysis was performed, and serum tryptase was equal to 189 µg/L, total IgE was 200 kU/L, and specific IgE dosage was positive for bee and yellow jacket species. Immunohistochemistry for tryptase detection was carried out, revealing mast cells and degranulated tryptase expression in the larynx, lungs, spleen, and heart. These findings led to the diagnosis of anaphylactic death due to Hymenoptera stings. CONCLUSIONS The case highlights that the role of biochemistry and immunohistochemistry in the postmortem assessment of anaphylactic reactions should be stressed by forensic practitioners.
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Affiliation(s)
- Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Gennaro Baldino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Elvira Ventura Spagnolo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
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Nuñez-Borque E, Fernandez-Bravo S, Yuste-Montalvo A, Esteban V. Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis. Front Immunol 2022; 13:836222. [PMID: 35371072 PMCID: PMC8965328 DOI: 10.3389/fimmu.2022.836222] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023] Open
Abstract
Anaphylaxis is a systemic hypersensitivity reaction that can be life threatening. Mechanistically, it results from the immune activation and release of a variety of mediators that give rise to the signs and symptoms of this pathological event. For years, most of the research in anaphylaxis has focused on the contribution of the immune component. However, approaches that shed light on the participation of other cellular and molecular agents are necessary. Among them, the vascular niche receives the various signals (e.g., histamine) that elicit the range of anaphylactic events. Cardiovascular manifestations such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and cardiac alterations are crucial in the pathophysiology of anaphylaxis and are highly involved to the development of the most severe cases. Specifically, the endothelium, vascular smooth muscle cells, and their molecular signaling outcomes play an essential role downstream of the immune reaction. Therefore, in this review, we synthesized the vascular changes observed during anaphylaxis as well as its cellular and molecular components. As the risk of anaphylaxis exists both in clinical procedures and in routine life, increasing our knowledge of the vascular physiology and their molecular mechanism will enable us to improve the clinical management and how to treat or prevent anaphylaxis. Key Message Anaphylaxis, the most severe allergic reaction, involves a variety of immune and non-immune molecular signals that give rise to its pathophysiological manifestations. Importantly, the vascular system is engaged in processes relevant to anaphylactic events such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and decreased cardiac output. The novelty of this review focuses on the fact that new studies will greatly improve the understanding of anaphylaxis when viewed from a vascular molecular angle and specifically from the endothelium. This knowledge will improve therapeutic options to treat or prevent anaphylaxis.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sergio Fernandez-Bravo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alma Yuste-Montalvo
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, Instituto en Investigación Sanitaria - Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
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8
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Yeo A, Kuek B, Lau M, Tan SR, Chan S. Post COVID-19 vaccine deaths - Singapore's early experience. Forensic Sci Int 2022; 332:111199. [PMID: 35078041 PMCID: PMC8767909 DOI: 10.1016/j.forsciint.2022.111199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Audrey Yeo
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore.
| | - Benjamin Kuek
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Mandy Lau
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shi Rui Tan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shijia Chan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
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Abstract
Purpose of Review The purpose of this review is to provide a better understanding of anaphylaxis pathophysiology and describe the underlying mechanisms, effector cells, and the potential biomarkers involved depending on the anaphylaxis endotypes. Recent Findings New insight into the potential relevance of pathways others than IgE-dependent anaphylaxis has been unraveled, as well as other biomarkers than tryptase, such as the role of platelet activation factor, basogranulin, dipeptidyl peptidase I, CCL-2, and other cytokines. Summary Gaining knowledge of all the mediators and cellular activation/communication pathways involved in each endotype of anaphylaxis will allow the application of precision medicine in patients with anaphylactic reactions, providing insights to the most appropriate approach in each case and helping to stratify severity and risk prediction.
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Heldring N, Kahn L, Zilg B. Fatal anaphylactic shock: A review of postmortem biomarkers and diagnostics. Forensic Sci Int 2021; 323:110814. [PMID: 33951572 DOI: 10.1016/j.forsciint.2021.110814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/21/2022]
Abstract
Diagnosing anaphylactic shock postmortem is challenging since differential diagnoses exist and the forensic pathologist often faces subtle findings and lacks relevant information which prevents reaching an opinion of certainty. This review provides an overview of the literature covering research and existing recommendations on the postmortem diagnosis of anaphylactic shock. In order to harmonize the approach and provide guidance for diagnosing deaths from anaphylactic shock in the six forensic centers in Sweden, a guidance protocol aligned with the notion of a holistic view in the approach was devised. Areas in need of further studies include both immunohistological and biochemical investigations to stratify quantitative approaches based on condition and anaphylactic trigger and to lay the ground for and possibly establish alternative matrices.
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Affiliation(s)
- Nina Heldring
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden.
| | - Lydia Kahn
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden
| | - Brita Zilg
- Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Retzius väg 5, SE-171 65 Stockholm, Sweden; Karolinska Institutet, Solnavägen 1, SE-171 77 Solna, Sweden
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11
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Reliable Postmortem Molecular Diagnosis of Anaphylaxis: Co-localization of Mast Cell Degranulation and Immunoglobulin E in Allergic Throat Tissues. Am J Forensic Med Pathol 2021; 41:249-258. [PMID: 32568883 PMCID: PMC7668346 DOI: 10.1097/paf.0000000000000572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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12
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Esposito M, Montana A, Liberto A, Filetti V, Nunno ND, Amico F, Salerno M, Loreto C, Sessa F. Anaphylactic Death: A New Forensic Workflow for Diagnosis. Healthcare (Basel) 2021; 9:healthcare9020117. [PMID: 33499408 PMCID: PMC7911323 DOI: 10.3390/healthcare9020117] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 01/26/2023] Open
Abstract
Anaphylaxis is a life-threatening or fatal clinical emergency characterized by rapid onset, and death may be sudden. The margin of certainty about the diagnosis of anaphylactic death is not well established. The application of immunohistochemical techniques combined with the evaluation of blood tryptase concentrations opened up a new field of investigation into anaphylactic death. The present study investigated eleven autopsy cases of anaphylactic death, carried out between 2005 and 2017, by the Departments of Forensic Pathology of the Universities of Foggia and Catania (Italy). An analysis of the medical records was carried out in all autopsies. Seven autopsies were carried out on males and four on females. Of the eleven cases, one showed a history of asthma, one of food ingestion, two of oral administration of medications, six did not refer any allergy history, and one subject was unknown. All cases (100%) showed pulmonary congestion and edema; 7/11 (64%) of the cases had pharyngeal/laryngeal edema and mucus plugging in the airway; only one case (9%) had a skin reaction that was found during external examination. Serum tryptase concentration was measured in ten cases, and the mean value was 133.5 µg/L ± 177.9. The immunohistochemical examination using an anti-tryptase antibody on samples from the lungs, pharynx/larynx, and skin site of medication injection showed that all cases (100%) were strongly immunopositive for anti-tryptase antibody staining on lung samples; three cases (30%) were strongly immunopositive for anti-tryptase antibody staining on pharyngeal/laryngeal samples; and eight cases (80%) were strongly immunopositive for anti-tryptase antibody staining on skin samples. We conclude that a typical clinical history, blood tryptase level >40 µg/L, and strongly positive anti-tryptase antibody staining in the immunohistochemical investigation may represent reliable parameters in the determination of anaphylactic death with the accuracy needed for forensic purposes.
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Affiliation(s)
- Massimiliano Esposito
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.E.); (A.M.); (A.L.); (F.A.)
| | - Angelo Montana
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.E.); (A.M.); (A.L.); (F.A.)
| | - Aldo Liberto
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.E.); (A.M.); (A.L.); (F.A.)
| | - Veronica Filetti
- Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, 95123 Catania, Italy; (V.F.); (C.L.)
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Francesco Amico
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.E.); (A.M.); (A.L.); (F.A.)
| | - Monica Salerno
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.E.); (A.M.); (A.L.); (F.A.)
- Correspondence: ; Tel.: +39-3735357201
| | - Carla Loreto
- Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, 95123 Catania, Italy; (V.F.); (C.L.)
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
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13
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Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int 2019; 297:384-387. [PMID: 30803735 DOI: 10.1016/j.forsciint.2019.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The spleen is only uncommonly investigated in the forensic setting. Thorough examinations are performed in some specific situations such as splenic trauma (including iatrogenic trauma from cardiopulmonary resuscitation attempts), anaphylaxis, drowning, and sepsis-related deaths. The aim of this review is to present the available literature focusing on a few selected splenic diseases as well as forensic investigations performed on the spleen in order to summarize the most frequent situations in which this routinely unexplored organ may merit more extensive examination.
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Affiliation(s)
- Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland.
| | | | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand
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14
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Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int 2018; 291:94-99. [PMID: 30173072 DOI: 10.1016/j.forsciint.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
Abstract
The spleen is infrequently investigated in forensic pathology routine. Thorough examinations are performed in very specific situations such as splenic trauma (including iatrogenic trauma from cardiopulmonary resuscitation attempts), anaphylaxis-related deaths, drowning and sepsis. The purpose of this review article is to provide a general overview of available literature focusing on a few selected splenic diseases as well as available forensic investigation techniques performed on the spleen in order to summarize the most frequent situations of forensic interest in which this routinely unexplored organ may merit more extensive examination.
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Affiliation(s)
- Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland.
| | | | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand
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15
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Abstract
Aim To review the available literature pertaining to fatalities following vaccine administration and, in particular, cases of vaccine-related fatal anaphylaxis. Method The MEDLINE database was systematically searched up to March 2016 to identify all relevant articles pertaining to fatal cases of anaphylaxis following vaccine administration. Results Six 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. Conclusion In 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.
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Affiliation(s)
- Cristian Palmiere
- Cristian Palmiere, CURML, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland,
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16
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Koniari I, Kounis NG, Soufras G, Koutsogiannis N, Hahalis G. Specific IgE levels in pericardial and cerebrospinal fluids in forensic casework. Forensic Sci Int 2017; 270:91-92. [DOI: 10.1016/j.forsciint.2016.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
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17
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Determination of specific IgE in pericardial and cerebrospinal fluids in forensic casework. Forensic Sci Int 2016; 267:204-209. [DOI: 10.1016/j.forsciint.2016.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/08/2016] [Accepted: 08/13/2016] [Indexed: 11/22/2022]
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18
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Postmortem detection of antibiotic-specific immunoglobulin E in the case of anaphylactic death. Forensic Sci Int 2016; 266:14-17. [DOI: 10.1016/j.forsciint.2016.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 02/05/2023]
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19
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Niedzwiecki M, Yamada Y, Inci I, Weder W, Jungraithmayr W. Decrease of Airway Allergies After Lung Transplantation Is Associated With Reduced Basophils and Eosinophils. Transplant Proc 2016; 48:2140-6. [PMID: 27569960 DOI: 10.1016/j.transproceed.2016.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/14/2016] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Allergies are hypersensitive reactions of the immune system on antigen exposure similar to immune reactions after transplantation (Tx). Their activity can change after Tx. The lung as a transplantable organ is challenged two-fold, by antigens from the blood and the air environment. Herein we analyzed if airway allergies change after lung Tx. METHODS We systematically reviewed patients' airway allergies before and after lung Tx between 1992 and 2014. The course of lymphocytes, thrombocytes, and leukocytes, among them neutrophils, eosinophils, and basophils, was analyzed in patients in whom airway allergies have changed and in whom they did not change. RESULTS From 362 lung transplanted patients, 44 patients had suffered from allergies before Tx (12.2%). In 20 of these patients (45.5%), airway allergies disappeared completely within 1 year after lung Tx and were persistently absent thereafter. In these patients, basophils and eosinophils decreased significantly (P < .0012); in contrast, cells did not decrease in patients whose allergies did not disappear. Leukocytes overall, and in particular, neutrophils, decreased significantly in patients whose allergy disappeared (P < .014, P < .012, respectively). CONCLUSIONS Airway allergies disappeared in almost half of cases after lung Tx. Along with this reduction, basophils and eosinophils decreased as potentially responsible cells for this phenomenon. These findings may stimulate intensified research on basophils and eosinophils as major drivers of airway allergies.
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Affiliation(s)
- M Niedzwiecki
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Y Yamada
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - I Inci
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - W Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - W Jungraithmayr
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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20
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Cecchi R. Diagnosis of anaphylactic death in forensics: Review and future perspectives. Leg Med (Tokyo) 2016; 22:75-81. [PMID: 27591544 DOI: 10.1016/j.legalmed.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 12/18/2022]
Abstract
The diagnosis of anaphylaxis in a pre- or post-mortal phase involves the formulation of problems not yet solved by the international scientific literature, due to the complexity of pathogenic factors and pathophysiological processes that characterizes it. For forensic autopsies, further problems of differential diagnosis arise and often leave the forensic pathologist unable to express an opinion of certainty, as a result of lack of case history, circumstantial and autoptical-histopathological data. Nevertheless, in routine cases the postmortem diagnosis of anaphylactic death continues to be based on exclusion and circumstantial evidence. The author, after an extensive review of the literature relating to deaths from anaphylaxis of forensic pathological interest, and a discussion of the microscopical and biochemical findings, proposes a diagnostic protocol for forensic purposes and evaluates the diagnostic perspectives enabled by the newly available analytic techniques and markers. Maybe, the application of omics methodologies could help in the future for anaphylaxis diagnosis.
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Affiliation(s)
- Rossana Cecchi
- Department of Biomedical, Biotechnological and Translational Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
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21
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Palmiere C. Postmortem diagnosis of drug-induced anaphylactic death. J Forensic Leg Med 2016; 41:28-9. [DOI: 10.1016/j.jflm.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 12/30/2022]
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22
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Radheshi E, Reggiani Bonetti L, Confortini A, Silingardi E, Palmiere C. Postmortem diagnosis of anaphylaxis in presence of decompositional changes. J Forensic Leg Med 2015; 38:97-100. [PMID: 26735898 DOI: 10.1016/j.jflm.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/12/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
Eosinophil and activated mast cell identification in the spleen combined with mast cell tryptase determination in postmortem serum may diagnose fatal anaphylaxis with a high degree of certainty. Mast cell tryptase measurement and significance in corpses with decompositional changes remains however an issue of controversy. Analogously, immunohistochemistry in corpses with decompositional changes may be influenced by several mechanisms, including protein alteration, antigen diffusion and unspecific antibody binding to disrupted protein structures. The authors present an autopsy case involving a 55-year-old woman who unintentionally received clarithromycin. Due to difficult in administrative procedures, the postmortem examination was performed 96 h after death. Mast cell tryptase was measured in postmortem serum from femoral, aortic and right heart blood. The obtained results were consistent with mast cell activation. Histochemistry (Pagoda Red) and immunohistochemistry (anti-tryptase antibodies) allowed splenic eosinophils and mast cells to be detected. Based on the results of all postmortem investigations, the hypothesis of anaphylaxis following accidental clarithromycin administration was formulated.
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Affiliation(s)
- Erjon Radheshi
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Medicina Legale, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Anatomia Patologica, Modena, Italy
| | - Annalisa Confortini
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Anatomia Patologica, Modena, Italy
| | - Enrico Silingardi
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Medicina Legale, Modena, Italy
| | - Cristian Palmiere
- University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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23
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Reggiani Bonetti L, Maccio L, Trani N, Radheshi E, Palmiere C. Splenic hypereosinophilia in anaphylaxis-related death: different assessments depending on different types of allergens? Int J Legal Med 2014; 129:97-103. [DOI: 10.1007/s00414-014-1004-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/16/2014] [Indexed: 01/11/2023]
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24
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Kounis NG, Soufras GD, Hahalis G. Accumulation of eosinophils, mast cells, and basophils in the spleen and the coronary arteries in anaphylactic deaths: is the Kounis hypersensitivity associated syndrome present? Forensic Sci Med Pathol 2013; 10:150-1. [DOI: 10.1007/s12024-013-9489-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
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