title: Postmortem diagnosis of acute anaphylaxis by serum tryptase analysis. A case report.
abstract: Systemic anaphylaxis is an acute allergic emergency resulting from generalized mast cell degranulation. In the United States, it is estimated that anaphylaxis accounts for about 500 deaths each year. Hymenoptera-sting hypersensitivity is one of the most common causes of systemic anaphylaxis. The authors report a case of a healthy 26-year-old man who developed acute anaphylaxis after a bee sting, could not be resuscitated, and died within 1 hour. At autopsy, performed 14 hours after the event, the only pathologic findings were laryngeal edema and congestion of lung. Postmortem tryptase levels in the blood were obtained and were instrumental in confirming a diagnosis of acute anaphylaxis. This case is reported to discuss the difficulties associated with using traditional histamine levels in making a diagnosis of anaphylaxis and to validate the value of using tryptase levels to document acute anaphylaxis as a cause of death, even when serum is not obtained until many hours after death.
authors.affiliation: Department of Pathology, University of Texas, Southwestern Medical Center, Dallas 75235.
authors.forename: M Q
authors.initials: MQ
authors.lastname: Ansari
authors.forename: J L
authors.initials: JL
authors.lastname: Zamora
authors.forename: M F
authors.initials: MF
authors.lastname: Lipscomb
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis*; D053818:Chymases; D004796:Clinical Enzyme Tests; D006801:Humans; D008297:Male; D012697:Serine Endopeptidases / Q000097:blood*; D013997:Time Factors; D053802:Tryptases
chemical_list: D012697:Serine Endopeptidases; C083294:chymase 2; D053818:Chymases; D053802:Tryptases