Yunginger J W, Nelson D R, Squillace D L, Jones R T, Holley K E, Hyma B A, Biedrzycki L, Sweeney K G, Sturner W Q, Schwartz L B
Department of Pediatrics, Mayo Clinic, Rochester, MN.
J Forensic Sci. 1991 May;36(3):857-65.
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 micrograms/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 (less than 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.
为建立一种有用的实验室方案以调查可能的致命性过敏反应病例，我们检测了19例过敏反应受害者死亡前或死亡后24小时内采集的血清中肥大细胞源性类胰蛋白酶水平和过敏原特异性免疫球蛋白E（IgE）抗体水平。在9例膜翅目昆虫叮咬致死病例中的9例、8例食物诱发致死病例中的6例以及2例诊断性治疗药物反应病例中的2例中，发现血清类胰蛋白酶水平升高（范围为12 ng/mL至150μg/mL）。从6例对照患者尸检后连续采集的57份血清中，类胰蛋白酶水平正常（低于10 ng/mL）。由于技术原因，无法在胸腔或心包积液中检测类胰蛋白酶。在9例膜翅目昆虫叮咬致死病例中的5例以及8例食物致死反应中的8例中，血清IgE抗体升高；对于2例诊断/治疗药物反应病例，无法进行检测。如果升高，受害者血清中针对食物的IgE抗体可用于识别过敏反应事件发生前不久食用的未食用食物部分中的过敏原。IgE抗体在室温下于多种抗凝剂中储存长达11周期间保持适度稳定。尸检血清中升高的肥大细胞源性类胰蛋白酶水平反映生前肥大细胞活化，可作为致命性过敏反应的标志物。如果有针对相关过敏原的IgE抗体检测方法，此类检测可为生前致敏提供证据；这些检测方法可进行改进，以识别食物诱发过敏反应受害者食用的食物中的过敏原。
