title: Anaphylaxis after the injection of buprenorphine.
abstract: Cause of death rulings in cases when the concentration of a drug or drugs is higher than observed following therapeutic use are generally straightforward "drug deaths." However, when toxicology testing identifies drug concentrations consistent with therapeutic use or detects no drugs at all, then the cause of death determination is more complicated. Given the rapidity and protean manifestations of anaphylaxis, it should be considered in deaths where no other cause of death is apparent in a suspected drug death. This article reports two cases where an anaphylactic reaction was observed following either the actual or alleged use of therapeutic formulations of buprenorphine intravenously.
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Cassie L
authors.initials: CL
authors.lastname: Boggs
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Ripple
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Zabiullah
authors.initials: Z
authors.lastname: Ali
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Melissa
authors.initials: M
authors.lastname: Brassell
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Barry
authors.initials: B
authors.lastname: Levine
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jufer-Phipps
authors.affiliation: Maryland Poison Center, 220 Arch Street, Baltimore, MD.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Doyon
authors.affiliation: Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
authors.forename: David R
authors.initials: DR
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced*; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects*; D004487:Edema / Q000473:pathology; D004804:Eosinophils / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D053593:Forensic Toxicology; D015726:Giant Cells / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D013287:Illicit Drugs / Q000009:adverse effects; D007275:Injections, Intravenous; D007830:Larynx / Q000473:pathology; D008168:Lung / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D009130:Muscle, Smooth / Q000473:pathology; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D015819:Substance Abuse, Intravenous / Q000150:complications; D053802:Tryptases / Q000097:blood
chemical_list: D013287:Illicit Drugs; D009294:Narcotics; D002047:Buprenorphine; D053802:Tryptases
keywords: anaphylaxis; buprenorphine; drug reaction; forensic science; injection; postmortem; toxicology; tryptase
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