title: Vaccination and anaphylaxis: a forensic perspective.
abstract: OBJECTIVE
  To review the available literature pertaining to fatalities following vaccine administration and, in particular, cases of vaccine-related fatal anaphylaxis.
  
  
  METHODS
  The MEDLINE database was systematically searched up to March 2016 to identify all relevant articles pertaining to fatal cases of anaphylaxis following vaccine administration.
  
  
  RESULTS
  Six papers pertaining to fatal anaphylaxis following vaccination were found relevant. Mast cell tryptase and total IgE concentration was assessed exclusively in one case. Laryngeal edema was not detected in any of these cases, whereas eosinophil or mast cell infiltration was observed in lymphoid organs. In one case, immunohistochemical investigations using anti-tryptase antibodies allowed pulmonary mast cells and degranulating mast cells with tryptase-positive material outside to be identified.
  
  
  CONCLUSIONS
  In any suspected IgE-mediated fatal anaphylactic cases, biochemical investigations should be systematically performed for forensic purposes. Splenic tissue should be routinely sampled for immunohistochemical investigations in all suspected anaphylaxis-related deaths and mast cell/eosinophil infiltrations should be systematically sought out in the spleen, myocardium, and coronary artery wall. The hypothesis of fatal anaphylaxis following vaccination should be formulated exclusively when circumstantial data, available medical records, laboratory investigations, and autopsy or histology findings converge in a consistent pattern. The reasonable exclusion of alternative causes of death after all postmortem investigations is also imperative in order to establish or rule out a cause-and-effect relationship between vaccine administration and any presumptive temporarily-related death.
authors.affiliation: Cristian Palmiere, CURML, Chemin de la Vulliette 4, 1000 Lausanne 25, Switzerland, cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.forename: Camilla
authors.initials: C
authors.lastname: Tettamanti
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Scarpelli
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D001344:Autopsy; D004804:Eosinophils / Q000378:metabolism; D006801:Humans; D008168:Lung / Q000378:metabolism; D008407:Mast Cells / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism; D013154:Spleen / Q000473:pathology; D014611:Vaccination / Q000009:adverse effects*