Legal Medicine Division, Sant'Andrea University Hospital, Rome, Italy.
Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.
Int J Immunopathol Pharmacol. 2020 Jan-Dec;34:2058738420950579. doi: 10.1177/2058738420950579.
Post-mortem investigation in cases of fatal anaphylaxis is required to provide clarifications on the presence of macroscopic pathological changes, histological features, and immunohistochemical positivity suggestive of the diagnosis, on biochemical evidence of anaphylaxis and on the presence of serological data indicative of the allergen responsible for the anaphylactic reaction. We describe the case of a 16-year-old boy with a medical history of allergic asthma, celiac disease, and known food-induced allergy for fish, fresh milk, peanuts, hazelnuts, walnuts, apples, kiwis, and peaches. Acute onset of dyspnea followed by cyanosis of the lips and respiratory failure was described immediately after having an ice cream sandwich. Unsuccessful rescues were immediately attempted with oral administration of betamethasone, intramuscular injection of adrenaline, and cardiopulmonary resuscitation. A complete post-mortem examination was performed. Serum dosage of mast cell beta-tryptase from femoral blood detecting serum values of 41.4 mg/l. Determination of specific IgE on cadaveric blood samples confirmed the anamnestic data related to sensitization for several food allergens, including cod parvalbumin, tropomyosin, brazil nut, omega-5-gliadin of foods derived from wheat and gluten. The cause of death was identified in a cardiorespiratory failure due to anaphylactic shock in a poly-allergic subject and anaphylaxis was ascribed to the wheat contained in the ice cream sandwich eaten immediately before the onset of respiratory symptoms. The need is to implement an interdisciplinary approach capable to ascertain the sensitivity and specificity of the diagnostic tests currently in use as well as to evaluate the possibility of introducing new biomarkers in practice.
对致命性过敏反应的尸检调查是必要的，以提供存在宏观病理变化、组织学特征和提示诊断的免疫组织化学阳性、过敏反应的生化证据以及表明导致过敏反应的过敏原的血清学数据的明确信息。我们描述了一名 16 岁男孩的病例，该男孩有过敏哮喘、乳糜泻病史，已知对鱼类、新鲜牛奶、花生、榛子、核桃、苹果、猕猴桃和桃子等食物过敏。在食用冰淇淋三明治后，立即出现呼吸困难、嘴唇发绀和呼吸衰竭的急性发作。立即尝试通过口服倍他米松、肌肉注射肾上腺素和心肺复苏术进行不成功的抢救。进行了全面的尸检检查。从股动脉血中检测到肥大细胞β-胰蛋白酶的血清剂量，检测到血清值为 41.4mg/l。对尸体血液样本中特异性 IgE 的测定证实了与多种食物过敏原致敏相关的病史，包括鳕鱼副肌球蛋白、原肌球蛋白、巴西坚果、源自小麦和谷蛋白的食物中的ω-5-麦胶。死因确定为多过敏个体的过敏反应性休克导致的心肺衰竭，并且将过敏反应归因于食用冰淇淋三明治前立即出现呼吸症状时所含的小麦。需要采取跨学科方法，以确定当前使用的诊断测试的敏感性和特异性，并评估在实践中引入新生物标志物的可能性。
