Laboratory Investigation of Deaths Due to Anaphylaxis
Yunginger, JW
Professor, Department of Pediatrics, fellow in pediatric allergy, Department of Pediatrics, research technicians, Allergic Diseases Research Laboratories, and professor of pathology, respectively, Mayo Clinic and Foundation, Rochester, MN.

Nelson, DR
Professor, Department of Pediatrics, fellow in pediatric allergy, Department of Pediatrics, research technicians, Allergic Diseases Research Laboratories, and professor of pathology, respectively, Mayo Clinic and Foundation, Rochester, MN.

Squillace, DL
Professor, Department of Pediatrics, fellow in pediatric allergy, Department of Pediatrics, research technicians, Allergic Diseases Research Laboratories, and professor of pathology, respectively, Mayo Clinic and Foundation, Rochester, MN.

Jones, RT
Professor, Department of Pediatrics, fellow in pediatric allergy, Department of Pediatrics, research technicians, Allergic Diseases Research Laboratories, and professor of pathology, respectively, Mayo Clinic and Foundation, Rochester, MN.

Holley, KE
Professor, Department of Pediatrics, fellow in pediatric allergy, Department of Pediatrics, research technicians, Allergic Diseases Research Laboratories, and professor of pathology, respectively, Mayo Clinic and Foundation, Rochester, MN.

Hyma, BA
Associate medical examiner, Office of the Medical Examiner, Metropolitan Dade County, Miami, FL.

Biedrzycki, L
Acting medical examiner, Oakland County Department of Institutional and Human Services, Pontiac, MI.

Sweeney, KG
Deputy chief medical examiner and chief medical examiner, respectively, Office of State Medical Examiners, Providence, RI.

Sturner, WQ
Deputy chief medical examiner and chief medical examiner, respectively, Office of State Medical Examiners, Providence, RI.

Schwartz, LB
Professor of medicine, microbiology, immunology, and pathology, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.


Abstract
To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 mg/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic/therapeutic agents. Tryptase levels were normal (&10 ng/mL) in 57 sequential sera obtained postmortem from six control patients. Tryptase could not be measured in pleural or pericardial fluids for technical reasons. Serum IgE antibodies were elevated in five of the nine Hymenoptera sting fatalities and in eight of the eight fatal food reactions; assays were unavailable for the two diagnostic/therapeutic agents. If elevated, the victim's serum IgE antibodies to food could be used to identify allergens in uneaten portions of foods consumed shortly before the anaphylactic event. IgE antibodies were moderately stable during storage in a variety of anticoagulants at room temperature for up to 11 weeks. Elevated mast-cell-derived tryptase levels in postmortem sera reflect antemortem mast cell activation and may be used as a marker for fatal anaphylaxis. If assays are available for IgE antibodies to relevant allergens, such assays provide evidence for antemortem sensitization; these assays may be modified to identify allergens in foods consumed by victims of food-induced anaphylaxis.

Keywords:
anaphylaxis, death, forensic science, immunoglobulin, immunoglobulins, mast cell-derived tryptase, pathology and biology, tryptase

Paper ID: JFS363910857

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Author Yunginger JW, Nelson DR, Squillace DL, Jones RT, Holley KE, Hyma BA, Biedrzycki L, Sweeney KG, Sturner WQ, Schwartz LB Title Laboratory Investigation of Deaths Due to Anaphylaxis Symposium , Committee on