Utility of biomarkers in the postmortem diagnosis of fatal Anaphylaxis: A scoping review

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine Pub Date : 2025-04-01 DOI:10.1016/j.legalmed.2025.102610

Bharath Karthikeyan , Ranjit Immanuel James , Jefferson Daniel , Senthil Kumar R , Benjy Tom Varughese , Daniel Manoj , Antony L. Arakkal , Latif Rajesh Johnson

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引用次数: 0

Abstract

Background

Diagnosing anaphylactic deaths is a challenging task for forensic pathologists. Although serum tryptase is considered to be a reliable biomarker, there are limitations to it. Thus, there is an urgent need to explore various other potential biomarkers which could be of diagnostic value, along with Tryptase, to diagnose anaphylactic shock at autopsy.

Aim

We want to systematically review the accuracy of newer postmortem biomarkers for anaphylaxis, such as chymase or eosinophilic cationic protein. Before embarking on this project, we intend to assess the feasibility of conducting systematic reviews on this topic. and identify any deficiencies in the existing literature to guide research priorities.

Methodology

We followed PRISMA guidelines and conducted the search in four databases, namely Medline, Scopus, EBSCO-CINAHL, and TRIP. Rayyan AI software was used to screen the articles.

Results

A total of 6112 articles were retrieved from the search, and 5079 articles were screened after removing duplicates. Only 25 articles were finally available as per our inclusion criteria. Studies pertaining to post-mortem tryptase levels were found in large numbers, with two recently done systematic reviews on this topic. The number of studies available on other newer biomarkers was too few. More clinical studies are needed before a meta-analysis can be done. Hence, we could perform only a narrative review on the topic.

Discussion

There is a scarcity of literature with definite cutoff levels for markers other than Tryptase. Based on the available studies, it is not possible to do diagnostic accuracy reviews at the moment. Hence, we narrate the usefulness of biomarkers like Immunoglobulin E, Chymase, Carboxypeptidase A3, Diamine Oxidase, Histamine and Eosinophilic Cationic Protein.

Conclusion

Based on the available evidence, serum tryptase is recognized as the primary biomarker for the postmortem diagnosis of anaphylactic death, with elevated levels strongly indicating anaphylaxis. Additionally, serum IgE, particularly allergen-specific IgE, is a valuable complementary biomarker. Further research is needed to understand the performance of other biomarkers.

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来源期刊

Legal Medicine Nursing-Issues, Ethics and Legal Aspects

CiteScore

2.80

自引率

6.70%

发文量

119

审稿时长

7.9 weeks

期刊介绍： Legal Medicine provides an international forum for the publication of original articles, reviews and correspondence on subjects that cover practical and theoretical areas of interest relating to the wide range of legal medicine. Subjects covered include forensic pathology, toxicology, odontology, anthropology, criminalistics, immunochemistry, hemogenetics and forensic aspects of biological science with emphasis on DNA analysis and molecular biology. Submissions dealing with medicolegal problems such as malpractice, insurance, child abuse or ethics in medical practice are also acceptable.