THE ANAPHYLAXIS HYPOTHESIS OF SUDDEN-INFANT-DEATH-SYNDROME (SIDS) - MAST-CELL DEGRANULATION IN COT DEATH REVEALED BY ELEVATED CONCENTRATIONS OF TRYPTASE IN SERUM

A series of cases of sudden unexpected post-neonatal deaths from two centres in the UK have been investigated for evidence of mast cell activation using the biochemical markers tryptase and 9 alpha,11 beta-PGF(2). Tryptase was selected as a possible marker because it is a component of mast cell secretory granules and, unlike histamine, it is not released from basophils. The prostaglandin 9 alpha,11 beta-PGF(2) is an initial and pharmacologically active metabolite of PGD(2), the major mast cell-derived cyclo-oxygenase product. This prostaglandin was chosen to serve as a marker of newly generated mediator release. In the study, unexplained infant deaths were associated with a higher concentration of tryptase in serum compared with cases of unexpected, but subsequently explained death. However, 9 alpha,11 beta-PGF(2) was found to be an unsuitable post mortem marker in this situation. These results provide direct evidence that mast cell degranulation, possibly as a result of anaphylaxis, may be occurring around the time of death in some cases of cot death.