Tomassini Luca, Ricchezze Giulia, Gambelunghe Cristiana, Lancia Massimo, Gramaccia Marco, De Micco Francesco, Fedeli Piergiorgio, Cingolani Mariano, Scendoni Roberto
International School of Advanced Studies, University of Camerino, Camerino, Italy.
Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
J Forensic Sci. 2025 Aug 6. doi: 10.1111/1556-4029.70147.
The postmortem diagnosis of anaphylaxis remains a forensic challenge due to the lack of specific external signs. Tryptase, a mast cell-derived protease, has emerged as a potential biomarker for fatal anaphylaxis. This systematic review critically examined 40 studies published between 2014 and 2024, including both biochemical and immunohistochemical analyses. Literature was identified through comprehensive searches of PubMed, Scopus, and Web of Science, following PRISMA guidelines. Biochemical studies consistently reported elevated postmortem β-tryptase levels in anaphylaxis-related deaths, with proposed diagnostic thresholds ranging from 30.4 to 64 μg/L. A diagnostic threshold of 53.8 μg/L demonstrated particularly strong discriminative capacity (AUC = 0.98; p < 0.001). Immunohistochemical analyses revealed an increased number of tryptase-positive mast cells in lung, pharynx, and skin tissues, but standardized protocols or quantification criteria were lacking. Notably, mast cell localization around bronchioles or vascular structures was more frequent in anaphylaxis cases. Despite promising findings, substantial heterogeneity in postmortem interval, sampling site, and analytical methodology limits the generalizability of current evidence. Elevated tryptase levels were also documented in non-anaphylactic deaths, underscoring its limited specificity. Overall, tryptase can support the postmortem diagnosis of anaphylaxis when interpreted in the context of autopsy findings, scene investigation, and clinical history. However, it should not be used as a standalone marker. Standardized protocols and combined biomarker panels are urgently needed to enhance diagnostic reliability in forensic settings.
由于缺乏特异性的外部体征，过敏性反应的尸检诊断仍然是一个法医学难题。类胰蛋白酶是一种肥大细胞衍生的蛋白酶，已成为致命性过敏性反应的潜在生物标志物。本系统评价严格审查了2014年至2024年间发表的40项研究，包括生化分析和免疫组化分析。按照PRISMA指南，通过全面检索PubMed、Scopus和科学网来确定文献。生化研究一致报告，在与过敏性反应相关的死亡病例中，死后β-类胰蛋白酶水平升高，建议的诊断阈值为30.4至64μg/L。53.8μg/L的诊断阈值显示出特别强的鉴别能力（AUC=0.98；p<0.001）。免疫组化分析显示，肺、咽和皮肤组织中类胰蛋白酶阳性肥大细胞数量增加，但缺乏标准化方案或定量标准。值得注意的是，在过敏性反应病例中，细支气管或血管结构周围的肥大细胞定位更为常见。尽管有这些有前景的发现，但死后间隔、采样部位和分析方法存在很大异质性，限制了当前证据的可推广性。在非过敏性反应死亡病例中也记录到类胰蛋白酶水平升高，这突出了其特异性有限。总体而言，在结合尸检结果、现场调查和临床病史进行解读时，类胰蛋白酶可支持过敏性反应的尸检诊断。然而，它不应作为独立的标志物使用。迫切需要标准化方案和联合生物标志物组合，以提高法医学环境中的诊断可靠性。
