Next Article in Journal
The Modern and Digital Transformation of Oral Health Care: A Mini Review
Next Article in Special Issue
A Descriptive Study on Causes of Death in Hospitalized Patients in an Acute General Hospital of Southern Italy during the Lockdown due to Covid-19 Outbreak
Previous Article in Journal
Analysis of Policies Based on the Multi-Fuzzy Regression Discontinuity, in Terms of the Number of Deaths in the Coronavirus Epidemic
Previous Article in Special Issue
Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review
 
 
Article

Anaphylactic Death: A New Forensic Workflow for Diagnosis

1
Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
2
Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, 95123 Catania, Italy
3
Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy
4
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Mariano Cingolani
Healthcare 2021, 9(2), 117; https://doi.org/10.3390/healthcare9020117
Received: 18 December 2020 / Revised: 11 January 2021 / Accepted: 20 January 2021 / Published: 22 January 2021
(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)
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. View Full-Text
Keywords: anaphylactic death; diagnostic workflow; immunohistochemical investigation; blood tryptase level anaphylactic death; diagnostic workflow; immunohistochemical investigation; blood tryptase level
Show Figures

Figure 1

MDPI and ACS Style

Esposito, M.; Montana, A.; Liberto, A.; Filetti, V.; Nunno, N.D.; Amico, F.; Salerno, M.; Loreto, C.; Sessa, F. Anaphylactic Death: A New Forensic Workflow for Diagnosis. Healthcare 2021, 9, 117. https://doi.org/10.3390/healthcare9020117

AMA Style

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. 2021; 9(2):117. https://doi.org/10.3390/healthcare9020117

Chicago/Turabian Style

Esposito, Massimiliano, Angelo Montana, Aldo Liberto, Veronica Filetti, Nunzio Di Nunno, Francesco Amico, Monica Salerno, Carla Loreto, and Francesco Sessa. 2021. "Anaphylactic Death: A New Forensic Workflow for Diagnosis" Healthcare 9, no. 2: 117. https://doi.org/10.3390/healthcare9020117

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop