Death of a doctor at cosmetic surgery clinic: What is Anaphylaxis?

The tragic death of 47-year-old Dr. P. A. Priyangi at a private cosmetic surgery clinic is believed to be a due to a reaction to a drug injected to her. After the judicial postmortem, some tissue samples have been sent to the Government Analyst for investigation. The exact cause of death of Dr. Priyangani can be known when results of the tests are available.

Serious allergic reactions of rapid onset that might cause death is called 'Anaphylaxis'. Common triggers for anaphylaxis include eggs, peanut, shellfish, food additives and colours, stinging insects, medications, for example, antimicrobial, antiviral, and antifungal agents, biologic agents such as the monoclonal antibodies, herbal formulations and diagnostic agents.

Deaths from anaphylaxis are often difficult to diagnose because of absence of historical details from eye witnesses, incomplete death scene investigations, paucity of specific pathologic findings at postmortem examinations, and lack of disease-specific laboratory tests.

My first encounter with a death from anaphylaxis was when some years ago a middle aged woman died at a clinic of a general practitioner, after she was injected with an antibiotic Streptomycin for a wound infection. In 2001, the famous singer Malani Bulathsinhala died from anaphylaxis said to be caused by a hair dye in Los Angeles.

The World Allergy Organisation Guidelines for the Assessment and Management of Anaphylaxis states that rapid assessment of the patient, treatment should begin with removal of exposure to the trigger, if possible. Then a doctor should assess the patient's circulation, airway, breathing, mental status, and skin, call for help, inject adrenaline (epinephrine) intramuscularly, place the patient on the back (or in a position of comfort if there is respiratory distress and/or vomiting), with

the lower extremities elevated, administer oxygen, insert an intravenous catheter to give intravenous fluid resuscitation, and initiate, if indicated, cardiopulmonary resuscitation.

Allergy testing may help in determining the trigger. Skin allergy testing (such as patch testing) is available for certain foods and venoms. Blood testing for spe- cific IgE can be useful to confirm milk, egg, peanut, tree nut and fish allergies

Skin testing is available to confirm penicillin allergies, but is not available for other medications. Non-immune forms of anaphylaxis can only be determined by history or exposure to the allergen in question, and not by skin or blood testing.