ABSTRACT
Anaphylaxis is an uncommon but under-recognised cause of death. Analysis of blood samples taken at autopsy or retrieved from laboratory investigations before death is essential and can provide data that may support or contradict anaphylaxis as a cause of death. This chapter provides a framework of knowledge, derived from a study of fatal allergic reactions that will help the pathologist recognise when anaphylaxis is a possible cause of death, and to assist in the selection of helpful immunological investigations. Animal studies have demonstrated alternative pathways to anaphylaxis but their role in human disease is unclear. Any proof that an allergic reaction has been the cause of death is often missing in deaths certified as due to anaphylaxis. In asphyxial deaths, histology of the upper airway mucosa may demonstrate oedema and an infiltrate of mast cells and eosinophils. Mast cell tryptase is a relatively stable protein and a raised level may be detectable for a few days in post-mortem blood.
