Abstract
Aims—To determine the frequency at which classic manifestations of anaphylaxis are present at necropsy after fatal anaphylactic reactions.
Methods—A register has been established of fatal anaphylactic reactions in the UK since 1992, traced from the certified cause of death and other sources. Details of the previous medical history and the reaction suggest anaphylaxis as the cause of death for 130 cases; a postmortem report was available for 56.
Results—The 56 deaths studied included 19 reactions to bee or wasp venom, 16 to foods, and 21 to drugs or contrast media. Death occurred within one hour of anaphylaxis in 39 cases. Macroscopic findings included signs of asthma (mucous plugging and/or hyperinflated lungs) (15 of 56), petechial haemorrhages (10 of 56), pharyngeal/laryngeal oedema (23 of 56), but for 23 of 56 there was nothing indicative of an allergic death. Mast cell tryptase was raised in 14 of 16 cases tested; three of three tested had detectable IgE specific for the suspected allergen.
Conclusions—In many cases of fatal anaphylaxis no specific macroscopic findings are present at postmortem examination. This reflects the rapidity and mode of death, which is often the result of shock rather than asphyxia. Investigations that might help determine whether anaphylaxis was the cause of death had rarely been performed. In the presence of a typical clinical history, absence of postmortem findings does not exclude the diagnosis of anaphylaxis.
Key Words: necropsy • anaphylaxis • asthma
Full Text
The Full Text of this article is available as a PDF (92.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adkinson N. F., Jr Beta-lactam crossreactivity. Clin Exp Allergy. 1998 Sep;28 (Suppl 4):37–40. [PubMed] [Google Scholar]
- Ansari M. Q., Zamora J. L., Lipscomb M. F. Postmortem diagnosis of acute anaphylaxis by serum tryptase analysis. A case report. Am J Clin Pathol. 1993 Jan;99(1):101–103. doi: 10.1093/ajcp/99.1.101. [DOI] [PubMed] [Google Scholar]
- Belton A. L., Chira T. Fatal anaphylactic reaction to hair dye. Am J Forensic Med Pathol. 1997 Sep;18(3):290–292. doi: 10.1097/00000433-199709000-00012. [DOI] [PubMed] [Google Scholar]
- Ciesielski-Carlucci C., Leong P., Jacobs C. Case report of anaphylaxis from cisplatin/paclitaxel and a review of their hypersensitivity reaction profiles. Am J Clin Oncol. 1997 Aug;20(4):373–375. doi: 10.1097/00000421-199708000-00010. [DOI] [PubMed] [Google Scholar]
- Delage C., Irey N. S. Anaphylactic deaths: a clinicopathologic study of 43 cases. J Forensic Sci. 1972 Oct;17(4):525–540. [PubMed] [Google Scholar]
- Edston E., van Hage-Hamsten M. beta-Tryptase measurements post-mortem in anaphylactic deaths and in controls. Forensic Sci Int. 1998 May 11;93(2-3):135–142. doi: 10.1016/s0379-0738(98)00040-1. [DOI] [PubMed] [Google Scholar]
- Foucard T., Malmheden Yman I. A study on severe food reactions in Sweden--is soy protein an underestimated cause of food anaphylaxis? Allergy. 1999 Mar;54(3):261–265. doi: 10.1034/j.1398-9995.1999.00924.x. [DOI] [PubMed] [Google Scholar]
- Hogan A. D., Schwartz L. B. Markers of mast cell degranulation. Methods. 1997 Sep;13(1):43–52. doi: 10.1006/meth.1997.0494. [DOI] [PubMed] [Google Scholar]
- Mosbech H. Death caused by wasp and bee stings in Denmark 1960-1980. Allergy. 1983 Apr;38(3):195–200. doi: 10.1111/j.1398-9995.1983.tb01606.x. [DOI] [PubMed] [Google Scholar]
- Patel F. Seafood-induced fatal anaphylaxis. Med Sci Law. 1998 Oct;38(4):354–357. doi: 10.1177/002580249803800413. [DOI] [PubMed] [Google Scholar]
- Prahlow J. A., Barnard J. J. Fatal anaphylaxis due to fire ant stings. Am J Forensic Med Pathol. 1998 Jun;19(2):137–142. doi: 10.1097/00000433-199806000-00007. [DOI] [PubMed] [Google Scholar]
- Randall B., Butts J., Halsey J. F. Elevated postmortem tryptase in the absence of anaphylaxis. J Forensic Sci. 1995 Mar;40(2):208–211. [PubMed] [Google Scholar]
- Salkie M. L., Mitchell I., Revers C. W., Karkhanis A., Butt J., Tough S., Green F. H. Postmortem serum levels of tryptase and total and specific IgE in fatal asthma. Allergy Asthma Proc. 1998 May-Jun;19(3):131–133. doi: 10.2500/108854198778604121. [DOI] [PubMed] [Google Scholar]
- Schwartz H. J., Yunginger J. W., Schwartz L. B. Is unrecognized anaphylaxis a cause of sudden unexpected death? Clin Exp Allergy. 1995 Sep;25(9):866–870. doi: 10.1111/j.1365-2222.1995.tb00029.x. [DOI] [PubMed] [Google Scholar]
- Schwartz L. B., Sakai K., Bradford T. R., Ren S., Zweiman B., Worobec A. S., Metcalfe D. D. The alpha form of human tryptase is the predominant type present in blood at baseline in normal subjects and is elevated in those with systemic mastocytosis. J Clin Invest. 1995 Dec;96(6):2702–2710. doi: 10.1172/JCI118337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz L. B., Yunginger J. W., Miller J., Bokhari R., Dull D. Time course of appearance and disappearance of human mast cell tryptase in the circulation after anaphylaxis. J Clin Invest. 1989 May;83(5):1551–1555. doi: 10.1172/JCI114051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vaughan S. T., Jones G. N. Systemic mastocytosis presenting as profound cardiovascular collapse during anaesthesia. Anaesthesia. 1998 Aug;53(8):804–807. doi: 10.1046/j.1365-2044.1998.00536.x. [DOI] [PubMed] [Google Scholar]
- Yunginger J. W., Nelson D. R., Squillace D. L., Jones R. T., Holley K. E., Hyma B. A., Biedrzycki L., Sweeney K. G., Sturner W. Q., Schwartz L. B. Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci. 1991 May;36(3):857–865. [PubMed] [Google Scholar]