Fatal anaphylactic shock is common in forensic practice. However, it is difficult to diagnose for lacking specific pathological and morphologic changes in forensic autopsy. The application of some biochemical indicators is of great significance. This paper reviews the biological characteristics of some biochemical indicators and detection methods. The forensic application, problems and prospects of these indicators are also introduced in details. The stable biochemical indicators, IgE, tryptase and chymase, show great potential and advantages in the identification of fatal anaphylactic shock in forensic medicine.
Anaphylaxis/metabolism* ; Autopsy ; Biomarkers ; Chymases ; Forensic Medicine ; Humans ; Tryptases

OBJECTIVE: To investigate the changes of the activity of tryptase of sera, lungs and bronchial tubes in the guinea-pigs which suffered from hetero-serum anaphylactic shock. METHODS: Sera and tissues were collected from anaphylactic shock guinea-pigs, and the enzyme activity was tested colormetrically using special substrate, BAPNA. RESULTS: The activity of tryptase of sera, lungs and bronchial tubes increased significantly in Anaphylactic guinea-pigs compared with control group. CONCLUSION The changes of tryptase activity are helpful to diagnose anaphylactic shock.
Anaphylaxis/enzymology* ; Animals ; Female ; Forensic Medicine ; Guinea Pigs ; Male ; Serine Endopeptidases/metabolism* ; Tryptases

Anaphylaxis is a life - threatening syndrome elicited in a hypersensitive individual on subsequent exposure to a sensitizing antigen with, reactions ranging widely in severity from mild pruritus and criteria to shock and death. Anaphylaxis occurs in the United States at rates estimated to be as high as one in every 3000 inpatients and may account for more than 500 deaths annually. Preparations of kelp Laminaria digitata are used as tents in gynecologic procedures to dilate the cervix, and the kelp consists principally of a glucagon carbohydrate called laminarin. Laminarin is thought to function as the active ingredient in dilatation by changing osmotic pressure or uterine prostaglandin metabolism. The tent is inserted into the cervix several hours before the procedure. As the cervix desiccates and dilates, the tent develops an hourglass shape. Recently, we experienced one patient with anaphylaxis to laminaria diagnosed by skin test and showing good response to treatment.
Anaphylaxis* ; Cervix Uteri ; Dilatation ; Female ; Glucagon ; Humans ; Inpatients ; Kelp ; Laminaria* ; Metabolism ; Osmotic Pressure ; Pruritus ; Shock ; Skin Tests ; United States

OBJECTIVE: To investigate the diagnostic significance of basophil activation test (BAT) in anaphylaxis to non-ionic contrast media through testing the content of CD63, mast cell-carboxypeptidase A3 (MC-CPA3), and terminal complement complex SC5b-9 of the individuals by testing their levels in the normal immune group and the anaphylaxis groups to β-lactam drugs and non -ionic contrast media. METHODS: The CD63 expression of basophilic granulocyte in blood was detected by flow cytometry. The levels of MC-CPA3 in blood serum and SC5b-9 in blood plasma were detected by ELISA. RESULTS: The CD63 expression of basophilic granulocyte in blood, the levels of MC-CPA3 and SC5b-9 of anaphylaxis to non-ionic contrast media and β-lactam drugs were significantly higher than that in normal immune group (P < 0.05). CONCLUSION There is activation of basophilic granulocytes, mast cells and complement system in anaphylaxis to non-ionic contrast media. BAT can be used to diagnose the anaphylaxis to non-ionic contrast media.
Anaphylaxis/diagnosis* ; Basophils/cytology* ; Carboxypeptidases A/metabolism* ; Complement Membrane Attack Complex/metabolism* ; Contrast Media ; Flow Cytometry ; Granulocytes/cytology* ; Humans ; Mast Cells/cytology* ; Tetraspanin 30/metabolism*

The death caused of anaphylactic shock is common in clinical medicine and medicolegal expertise, but it is a nodus to diagnose sudden death from allergy. In recent years, to provide objective and precise morphological evidence and index of diagnosis for sudden death from allergy, scholars of internal and overseas studied the content of IgE, HT, mast cell tryptase and SP in the serum of the death died of anaphylactic shock, and their immune express in lung and stomach intestine. In this text we reviewed the present study and existing problems of the forensic medicine diagnosis of the sudden erethistic death.
Anaphylaxis/pathology* ; Death, Sudden ; Forensic Pathology ; Gastric Mucosa/metabolism* ; Histamine/metabolism* ; Humans ; Immunoglobulin E/metabolism* ; Immunohistochemistry ; Intestinal Mucosa/metabolism* ; Mast Cells/enzymology* ; Retrospective Studies ; Substance P/metabolism* ; Trypsin/metabolism*

OBJECTIVE: To seek the pathomorphological targets for forensic expertise in anaphylactic shock. METHODS: The expression of IgE in hearts, lungs, livers, spleens, kidneys, gastrics, intestinals, tracheas and tonsils of anaphylactic shock guinea-pigs was observed at 0, 6, 12 h and 24 h respectively by tissue chip S-P immuno-histochemical method. RESULTS: Positive expression of IgE presented in lungs and tracheas in the test group with the peak at 0 hour and it declined as time advanced, and also there were significant differences at different times (P<0.05). CONCLUSION The immuno-histochemical method of detecting the expression of IgE in lungs, tracheas and spleens can be supposed to be the pathomorphological targets for forensic expertise in anaphylactic shock. The weakening of the positive expression of IgE in lungs and tracheas as the time advanced suggested that in this kind of case the autopsy should be arried out as early as possible.
Allergens/administration & dosage* ; Anaphylaxis/metabolism* ; Animals ; Disease Models, Animal ; Female ; Forensic Pathology ; Guinea Pigs ; Immunoglobulin E/analysis* ; Immunohistochemistry ; Lung/metabolism* ; Male ; Myocardium/metabolism* ; Postmortem Changes ; Spleen/metabolism* ; Time Factors ; Trachea/metabolism*

OBJECTIVE: To study the expression of substance P (SP) in human sudden erethistic death, and to seek objective morphological supports to diagnose sudden erethistic death for forensic medicine. METHODS: The expression of SP was detected with immunohistochemical technique on 15 human laryngopharynx and gastrointestine of sudden erethistic death, and 20 sudden death of heart attack as control. The images of SP were analyzed by image analyzer, and the positive indexes (PI) were calculated. RESULTS: SP expression in the experimental groups was significantly stronger than that in the control one (P < 0.001). CONCLUSION SP expression can offer an objective morphological reference support for forensic diagnosing sudden erethistic death.
Adolescent ; Adult ; Anaphylaxis/pathology* ; Autopsy ; Child ; Death, Sudden ; Death, Sudden, Cardiac/pathology* ; Female ; Gastric Mucosa/metabolism* ; Humans ; Immunohistochemistry ; Intestinal Mucosa/metabolism* ; Male ; Middle Aged ; Mucous Membrane/metabolism* ; Pharynx/metabolism* ; Substance P/metabolism* ; Young Adult

AIMTo investigate the effect of cetirizine hydrochloride on the expression of neuropeptide substance P (SP) in IgE-dependent triphasic cutaneous reaction induced by dinitrofluorobenzene (DNFB) in the ears of BALB/c mice.

METHODSBALB/c mice were passively sensitized by intravenous infection of anti-DNP IgE monoclonal antibody 24 h before DNFB challenge. Skin reaction was elicited by applying DNFB to both sides of each ear of sensitized mice. Mice were treated with cetirizine (1 and 10 mg x kg)-1), ig). The ears were removed for pathohistological examination and immunohistochemical staining of SP at different designated times after challenge. The contents of SP in the skin of mouse ear were determined by radioimmunoassay (RIA).

RESULTSThe mice exhibited a triphasic cutaneous reaction with an immediate-phase response (IPR) at 1 h, a late-phase response (LPR) at 24 h and a very late-phase response (vLPR) at 7 days after challenge with DNFB. The expression of SP in different phases increased gradually. Cetirizine (1 and 10 mg x kg(-1)) was shown to significantly inhibit the ear swellings induced by the IPR (P < 0.01), while no obvious effect on the vLPR. The SP contents in ear skin of triphasic cutaneous reaction were decreased by cetirizine.

CONCLUSIONSP is considered to be involved in the pathogenesis of allergic dermatitis. Cetirizine hydrochloride can inhibit the expression of SP in IgE-dependent triphasic cutaneous reaction. It might be part of the mechanisms of anti-anaphylaxis of cetirizine.

Animals ; Anti-Allergic Agents ; pharmacology ; Cetirizine ; pharmacology ; Dose-Response Relationship, Drug ; Ear ; Edema ; metabolism ; Female ; Hypersensitivity, Delayed ; metabolism ; Hypersensitivity, Immediate ; metabolism ; Immunoglobulin E ; immunology ; Mice ; Mice, Inbred BALB C ; Passive Cutaneous Anaphylaxis ; drug effects ; Substance P ; metabolism

OBJECTIVE: To investigate the effect and expression of the vascular cell adhesion molecule-1 (VCAM-1) in organs of rats died of anaphylactic shock. METHODS: The models of anaphylactic shock in rats were made and the immunohistochemistry of SABC was used to detect as follows: (1) The expression of VCAM-1 in rat lung, heart, brain, kidney, liver, spleen, stomach and intestine. (2) VCAM-1 levels in lungs at 10 min, 30 min after the allergic shock, and the time of death. (3) VCAM-1 levels in lungs of rats after the intervention of anti-VCAM-1. RESULTS: After the death, the expression VCAM-1 in lungs increased significantly relative to the control group and followed the extension of shock. In the rats which were injected with the anti-VCAM-1, the expression of VCAM-1 in lungs reduced. CONCLUSION (1) The expression of VCAM-1 shows difference in the various organs of rats after anaphylactic shock. The change of VCAM-1 is the most obvious in lungs and would increase followed the extension of anaphylactic shock. (2) After the anaphylactic shock, anti-VCAM-1 can inhibit the expression of VCAM-1 in rat lung.
Anaphylaxis/pathology* ; Animals ; Antibodies, Monoclonal/therapeutic use* ; Brain/metabolism* ; Disease Models, Animal ; Female ; Immunohistochemistry ; Kidney/metabolism* ; Lung/metabolism* ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Time Factors ; Vascular Cell Adhesion Molecule-1/metabolism*

BACKGOUND: For rapid onset and predictable elimination half life, remifentanil may be suitable for patients undergoing cardiac surgery with unstable vital sign and decreased metabolism. We evaluated the efficacy, safety and proper dosage of intravenous patient-controlled analgesia (IV PCA) using remifentanil in patients undergoing cardiac surgery. METHODS: Forty-nine patients scheduled for cardiac surgery with sternotomy were randomly allocated to three groups. Group F had IV PCA using fentanyl with basal rate of 0.3microgram/kg/h, bolus of 0.5microgram/kg and lockout time of 15 min. Group L had remifentanil IV PCA with basal rate of 4microgram/kg/h, and group S with basal rate of 1microgram/kg/h. Both of group L and group S had setting of bolus of 0.5microgram/kg and lockout time of 5 min. In 12, 24 and 36 hours after surgery, vital sign, arterial blood gas analysis, visual analog pain scale (VAS), sedation score, and incidences of side effects were evaluated. RESULTS: The VAS score of group L was significantly low until 24 hours after surgery compared with other groups (P < 0.001). In group L, sedation score and PaCO2 in 12 hours after surgery were significantly high compared with other groups (P < 0.05), but no treatments were needed. CONCLUSIONS: Remifentanil IV PCA with basal rate of 4microgram/kg/h showed lower VAS score compared with small dosage of remifentanil and fentanyl with basal rate of 0.3microgram/kg/h. In the safety and proper dosage, further evaluations were needed.
Analgesia, Patient-Controlled* ; Blood Gas Analysis ; Fentanyl ; Half-Life ; Humans ; Incidence ; Metabolism ; Pain Measurement ; Passive Cutaneous Anaphylaxis ; Sternotomy ; Thoracic Surgery* ; Vital Signs