Death in anaphylaxis often occurs suddenly and outside hospitals. The incidence of fatal outcome is not known with certainty but has been estimated to be about 1% of the total incidence of anaphylaxis per year. The morphology of anaphylaxis is nonspecific. In rapidly occurring deaths, the only finding might be visceral congestion. In more prolonged agony, the main findings are airway obstruction caused by edema and mucous plugging. Microscopical 268 Edston and Hage-Hamsten examination occasionally reveals edema in the respiratory mucosa, discrete inflammation with eosinophilia, and epithelial desquamation. The number of mast cells in different organs and tissues in anaphylactic deaths has hitherto not been properly evaluated. Furthermore, mast cells that have degranulated are difficult to identify in postmortem tissues. The development of immuno- logical methods to detect and quantify mast cell proteases, especially tryptase, has made it easier to diagnose or confirm anaphylaxis postmortem in quite a few cases. But tryptase may not be elevated when death occurs very suddenly and in deaths caused by food anaphylaxis. Moreover, it has been found that tryptase can be elevated in a few cases believed not to be caused by allergy. An artifactual increase of tryptase caused by postmortem diffusion from tis- sues into blood might also occur. Knowledge of the patient' s history and cir- cumstances of death is of major importance when investigating suspected anaphylaxis. Tryptase measurements should always be accompanied with analysis of allergen-specific immunoglobulin E antibodies or, if no allergen is known, a panel of common airborne and food allergens.
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CITATION STYLE
Edston, E., & van Hage-Hamsten, M. (2005). Postmortem Diagnosis of Anaphylaxis. In Forensic Pathology Reviews (pp. 267–281). Humana Press. https://doi.org/10.1007/978-1-59259-910-3_8