Postmortem findings after fatal anaphylactic reactions

Aims-To determine the frequency at which classic manifestations of anaphyla xis 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 sourc es. Details of the previous medical history and the reaction suggest anaphy laxis as the cause of death for 130 cases; a postmortem report was availabl e for 56. Results-The 56 deaths studied included 19 reactions to bee or wasp venom, 1 6 to foods, and 21 to drugs or contrast media. Death occurred within one ho ur of anaphylaxis in 39 cases. Macroscopic findings included signs of asthm a (mucous plugging and/or hyperinflated lungs) (15 of 56), petechial haemor rhages (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 s pecific for the suspected allergen. Conclusions-In many cases of fatal anaphylaxis no specific macroscopic find ings are present at postmortem examination. This reflects the rapidity and mode of death, which is often the result of shock rather than asphyxia. Inv estigations that might help determine whether anaphylaxis was the cause of death had rarely been performed. In the presence of a typical clinical hist ory, absence of postmortem findings does not exclude the diagnosis of anaph ylaxis.