The heart was normal, with a conical shape and slightly represented subepicardial fat

The heart was normal, with a conical shape and slightly represented subepicardial fat. 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. strong class=”kwd-title” Keywords: beta tryptase, food allergens, food-induced allergy, IgE, mast-cells, Wheat Introduction Food-induced anaphylaxis (FIA) is defined as an adverse reaction due to a specific and reproducible immune response resulting from exposure to a particular food.1 According to international recommendations, this definition includes IgE-mediated and non-IgE mediated immune responses, as well as the combination of both mechanisms.2C3 Food allergens can cause reactions by ingestion or contact. At present, a large amount of food has been identified as a cause of IgE-mediated phenomena, although the majority of allergic reactions is attributable to a limited number of foods such as peanuts, tree nuts, egg, milk, fish, shellfish, wheat, and soy.4 Food-induced anaphylaxis is a rare cause of Azatadine dimaleate death and it is difficult to study as it very often represents a community event that occurs outside the hospital setting.5C6 Although the precise incidence of anaphylaxis mortality is still unknown, several retrospective post-mortem and population studies estimate the mortality rate to be 0.65%C2%. Fatal food-induced allergy usually presents acutely (from a few minutes to several hours) after exposure to a known allergen with two or more of the following symptoms: generalized urticaria, itching or redness, rhinorrhea, conjunctivitis, swelling of the lips, tongue or uvula, respiratory impairment with dyspnea, wheezing, bronchospasm and hypoxia, cardiovascular compromise with hypotension, tachycardia, and Azatadine dimaleate collapse. Death due to anaphylaxis is Azatadine dimaleate usually due to heterogeneous mechanisms, often combined, including upper airway obstruction, asphyxia from bronchospasm, cardiogenic shock and, sometimes, hemorrhagic or thromboembolic phenomena.7 Case report The case presented concerns 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 2?days after death. No putrefaction phenomena were evident. External examination was unremarkable. Subpleural petechiae and heavy lungs presenting white foam on the main bronchi were observed at the autopsy investigation. Mild cerebral edema was also detected. The heart was normal, with a conical shape and slightly represented subepicardial fat. Coronary arteries were normal, and obstructions of the lumen were excluded. The laryngo-tracheo-bronchial tree did not show macroscopically detectable pathological findings. The stomach contained about 200?cc of partially digested food. All tissue specimens were fixed in formalin and embedded in paraffin, then a ARHGDIA routine hematoxylin and eosin stain was employed. Ubiquitous acute stasis, mild cerebral edema and interstitial myocardial edema were recorded. In addition, acute pulmonary edema mixed with areas of acute pulmonary emphysema were present. Intraparenchymal hemorrhages on the spleen and adrenal glands were observed (Figure 1). An immunohistochemical technique was used to estimate mast-cell population, using the anti-tryptase antibody as a specific marker on 5?mm thick paraffin sections. Afterward, a pulmonary area of 100?mm2 was analyzed. We examined histological samples from a control group where the cause of death was clearly attributable to traumatic events. Pulmonary mast cells were identified and quantified and a great number of degranulating mast cells with tryptase-positive material outside were observed (Figure 2). Data resulting from quantitative analysis recorded a numerical increase in pulmonary mast cells in this case (average mast-cell count 12,551/100?mm2) compared with that of the traumatic control group (traumatic death) whose average mast-cell count was 3557/100?mm2. The microscopic examination of duodenal samples stained with anti-CD3 and.

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