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Article history: Diagnosis of lethal anaphylaxis is known to be difficult to establish in forensic autopsy. Cases of
Received 11 May 2009 anaphylactic shock have to be dealt with in forensic medicine comparatively frequently as death due to
Received in revised form 12 December 2009 anaphylaxis is likely to occur rapidly and without warning in seemingly healthy subjects. Autopsy
Accepted 17 January 2010
findings might hint at allergic reaction, but classic manifestations can also be completely absent.
Available online 2 March 2010
A case of suspected food anaphylaxis in a middle-aged woman is presented. The deceased had been
known to suffer from multiple allergies. Death came about after an evening meal with friends. Dyspnoea
Keywords:
was reported to have been followed by collapse, unconsciousness and death within minutes. The course
Anaphylaxis
Unexpected death
of further analysis undertaken (toxicology, biochemistry, immunohistochemistry) is examplarily
Anti-tryptase described. By means of the results presented we discuss problems and possibilities of postmortem
diagnostics of food induced anaphylaxis.
ß 2010 Elsevier Ireland Ltd. All rights reserved.
0379-0738/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.forsciint.2010.01.007
e2 S. Unkrig et al. / Forensic Science International 198 (2010) e1–e4
administration of antihistamines and bronchospasmolytics. Dra- not been capable to establish cause of death but were definitely a
matic episodes of anaphylactic reactions had not been observed hint for fatal anaphylaxis.
before. Immunohistochemistry: Mast cell degranulation is an important
During the postmortem interrogation allergies were mentioned trigger of anaphylactic reactions. At this stage of investigation it
to the investigators and thus became known to the autopsy team. seemed essential to try to make visible acute mast cell
Evaluating possible reasons of death, for instance poisoning, the degranulation in body tissues. Staining of the mast cells with
investigators focused on the contains of the meal served for dinner specific markers (CD 117 and especially anti-tryptase antibodies)
that had taken place shortly before the symptoms’ onset. Dinner was performed. As shown in Figs. 1–3, a lot of preparations mast
had consisted of several courses and the first symptoms seemed to cells were found to have starry sky-like or yard-like distributed
have occurred about two hours after the entree. The meal had material around them. They showed reaction to anti-tryptase in
consisted of crabs, pasta, green salad and white wine. Finally, a the cells but also around the cells in the extracellular space. These
dessert which consisted of almond ice-cream with brownies and
orange liquor (all finished products) had been served about 10 min
before the onset of symptoms.
3. Autopsy/histological findings
5. Discussion
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