Medical and pathologic characteristics of fatal anaphylaxis: a Spanish nationwide 17-year series

Martínez‐Fernández, Pilar; Vallejo-de-Torres, Gloria; Sánchez-de-León-Robles, M. Soledad; Navarro-Escayola, Esperanza; Moro‐Moro, Mar; Alberti-Masgrau, Nuria; Tejedor-Alonso, Miguel A

doi:10.1007/s12024-019-00134-1

Cited by 8 publications

(13 citation statements)

References 30 publications

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“…Angioedema can affect all layers of the skin and visceral walls, such as the respiratory system and the gastrointestinal tract ( 171 , 173 , 174 ). Furthermore, angioedema of the upper airways or pulmonary edema has been observed in one out of two human anaphylactic biopsies indicating the necessity to control vascular permeability ( 18 ). Importantly, the endothelial IL-4 receptor α chain (IL-4Rα) and its underlying signaling appears as relevant in the gastrointestinal extravasation disturbances associated with food allergic reactions ( 175 ).…”

Section: Cardiovascular Pathophysiology Of Anaphylaxismentioning

confidence: 99%

“…Other systems may be affected, such as the gastrointestinal (e.g., emesis, diarrhea), nervous (e.g., confusion, drowsiness, seizure), respiratory (e.g., dyspnea, cough, wheezing, bronchoconstriction), and circulatory (e.g., palpitations, tachycardia, hypotension) (16). The cardiovascular system is highly involved during mild anaphylactic reactions and plays a key role in the most severe cases, in which anaphylactic shock could take place (17,18). Deterioration of the circulatory system due to age, other diseases, and treatments administered such as angiotensin-converting enzyme inhibitors are some of the main risk factors associated with fatal reactions (19)(20)(21).…”

Section: Anaphylaxismentioning

confidence: 99%

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Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis

et al. 2022

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Anaphylaxis is a systemic hypersensitivity reaction that can be life threatening. Mechanistically, it results from the immune activation and release of a variety of mediators that give rise to the signs and symptoms of this pathological event. For years, most of the research in anaphylaxis has focused on the contribution of the immune component. However, approaches that shed light on the participation of other cellular and molecular agents are necessary. Among them, the vascular niche receives the various signals (e.g., histamine) that elicit the range of anaphylactic events. Cardiovascular manifestations such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and cardiac alterations are crucial in the pathophysiology of anaphylaxis and are highly involved to the development of the most severe cases. Specifically, the endothelium, vascular smooth muscle cells, and their molecular signaling outcomes play an essential role downstream of the immune reaction. Therefore, in this review, we synthesized the vascular changes observed during anaphylaxis as well as its cellular and molecular components. As the risk of anaphylaxis exists both in clinical procedures and in routine life, increasing our knowledge of the vascular physiology and their molecular mechanism will enable us to improve the clinical management and how to treat or prevent anaphylaxis.Key MessageAnaphylaxis, the most severe allergic reaction, involves a variety of immune and non-immune molecular signals that give rise to its pathophysiological manifestations. Importantly, the vascular system is engaged in processes relevant to anaphylactic events such as increased vascular permeability, vasodilation, hypotension, vasoconstriction, and decreased cardiac output. The novelty of this review focuses on the fact that new studies will greatly improve the understanding of anaphylaxis when viewed from a vascular molecular angle and specifically from the endothelium. This knowledge will improve therapeutic options to treat or prevent anaphylaxis.

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Section: Cardiovascular Pathophysiology Of Anaphylaxismentioning

confidence: 99%

Section: Anaphylaxismentioning

confidence: 99%

Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis

et al. 2022

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“…Os fatores desencadeantes também diferem muitas vezes dos observados nos doentes mais jovens. Foi demonstrado que a anafilaxia de causa iatrogénica resultante da utilização de fármacos ou meios de contraste iodado aumentava com a idade, estando também associada a uma maior gravidade nos doentes idosos (6,15,16,19,40,41) . A frequência de doentes polimedicados aumenta com o envelhecimento, facilitando a possibilidade de sensibilização devido à maior exposição do indivíduo a múltiplos fármacos, podendo desta forma resultar num aumento do risco de reação de hipersensibilidade a fármacos (41) .…”

Section: Etiologiaunclassified

Anafilaxia no idoso: Particularidades na abordagem diagnóstica e terapêutica

Brosseron¹,

Ferreira²

2022

rpia

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Com o aumento global da esperança média de vida e consequente prevalência crescente de patologias relacionadas com o envelhecimento, as doenças do foro alérgico não são exceção, sendo cada vez mais frequentes na prática clínica diária. A anafilaxia, enquanto reação de hipersensibilidade grave e potencialmente fatal, encontra -se associada a uma maior morbimortalidade nesta faixa etária, apresentando particularidades próprias que merecem ser destacadas, não só ao nível do diagnóstico, como do seu tratamento. A presença de múltiplas comorbilidades e consequente polimedicação, frequentemente com fármacos anti -hipertensores que podem não só condicionar reações anafiláticas, como também dificultar o tratamento destas, juntamente com o predomínio de sintomas cardiovasculares e outros fatores inerentes ao envelhecimento, conferem maior vulnerabilidade a esta população. Assim, torna -se pertinente identificar e sensibilizar os profissionais de saúde para a existência de características particulares da anafilaxia no idoso, de modo a permitir uma intervenção mais direcionada e uma melhoria no prognóstico destes doentes.

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“…79 Pumphrey reported that the main indicators of possible anaphylactic death are: cutaneous erythema or angioedema (5%), upper-airway mucosal congestion and edema (8-49%), acute lung hyperinflation, and mucous plugging with bronchial mucosal congestion and hypereosinophilia (26%) (with airway remodelling, basement membrane thickening, mucinous metaplasia, and bronchial wall inflammatory cell infiltration also present in chronic asthmatic subjects), and asphyxial petechiae (17%). 13,79,[81][82][83][84][85] Pulmonary congestion and edema with splanchnic congestion (spleen, liver, kidneys) is also frequently detected (73%) as a result of cardiovascular decompensation and shock, and brain edema resulting from subsequent cerebral hypoxia (26%). 13,79,[81][82][83][84][85] In addition to eosinophils, mast cells and basophils must also be histologically analyzed in lung, heart, and parenchymal tissues using conventional (hematoxylin-eosin, Giemsa) or immunohistochemical (CD117, anti-tryptase, anti-chymase) staining.…”

Section: Medicolegal Implicationsmentioning

confidence: 99%

“…13,79,[81][82][83][84][85] In addition to eosinophils, mast cells and basophils must also be histologically analyzed in lung, heart, and parenchymal tissues using conventional (hematoxylin-eosin, Giemsa) or immunohistochemical (CD117, anti-tryptase, anti-chymase) staining. 13,79,83,[85][86][87] All materials present inside the gastric or intestinal cavities must always be sampled and exhaustively examined in suspected or known food allergy (ie, vegetable or fish). Yunginger et al 79,84 also suggested using the deceased's serum containing IgE antibodies to identify allergens in uneaten portions of food consumed shortly before the anaphylactic event.…”

Section: Medicolegal Implicationsmentioning

confidence: 99%

Medicolegal Implications of Biphasic Anaphylaxis

Broi

Moreschi

Marega

et al. 2020

Am J Forensic Med Pathol

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Biphasic anaphylaxis is an uncommon IgE-mediated condition whose pathophysiological mechanisms, risk factors, and predictive signs are not properly understood. Fortunately, the lethality of biphasic anaphylaxis, although probably underestimated, is low. Preventive clinical measures for biphasic anaphylaxis are neither standardized nor commonly applied. Furthermore, there are no laboratory protocols or anaphylactic markers to help identify the onset of biphasic anaphylaxis in clinical settings. The aim of this review is to highlight the medicolegal difficulties facing coroners and forensic pathologists in terms of the diagnosis and assessment of harm for victims and survivors of biphasic anaphylaxis.

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Medical and pathologic characteristics of fatal anaphylaxis: a Spanish nationwide 17-year series

Cited by 8 publications

References 30 publications

Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis

Pathophysiological, Cellular, and Molecular Events of the Vascular System in Anaphylaxis

Anafilaxia no idoso: Particularidades na abordagem diagnóstica e terapêutica

Medicolegal Implications of Biphasic Anaphylaxis

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