Serum tryptase, Immunoglobuline E assay and circumstantial data are fundamental tools for the post-mortem diagnosis of food anaphylaxis: a case report and literature review

Introduction. The most recent literature suggests that postmortem diagnosis of anaphylaxis remains a significant challenge for pathologists. Even with autopsy examination, the diagnosis of anaphylactic shock is difficult due to the complexity of the pathogenetic factors and the lack of pathognomonic data. Case presentation. The authors present a case of death for anaphylactic shock after food ingestion. Laboratory examinations carried out on blood taken from femoral arteries, approximately 5 hours after death, showed a value of 120 ng/ L of tryptase (n.v. <11.4 ng/ L) . Examination aimed at detecting IgE confirmed the existence of milk proteins allergy. Autopsy findings were suggestive of sudden death of cardiovascular origin, characterized by multi-organ congestion, petechiae and tracheal and bronchial foam. Conclusions. The combination of autopsy findings with serum tryptase and immunoglobuline E assay, histological preparations and anamnestic-circumstantial data provided the necessary elements for the postmortem diagnosis of anaphylactic shock caused by milk proteins ingestion.