Recent studies suggest that many fatal
heroin overdoses are caused by
anaphylactoid reaction. In the present study we measured
tryptase and
eosinophil cationic protein in post-mortem blood of 48 deaths after
heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for
tryptase and morphometric evaluation in those cases of
heroin-related deaths. The data were compared with 44 subjects who died following
head trauma and to 32 cases of fatal
anaphylactic shock. In the
heroin-related death cases, the measurements of serum
tryptase levels and
eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the
trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal
heroin overdose cases and the control groups. Furthermore, the wide range of
morphine concentrations found in post-mortem blood samples suggest that the term 'overdose' is relative and does not sufficiently characterize death associated with
heroin addiction. Our study confirms that elevated concentrations of serum
tryptase are associated with many
heroin-related deaths. At this moment to attribute the cause of these deaths to '
heroin overdose' ignores the likely causal contribution of other possible systemic reactions to the mechanism of death.