Fatal reactions to hymenoptera stings

Previous studies measuring immunoglobulin E (IgE) antibodies in postmortem sera for determining the cause of fatal anaphylaxis have reported only single cases or small groups. Recently, more attention has been paid to reports of patients with venom allergies who are negative by venom skin testing, by in vitro testing or by both tests. The aim of this study was to determine the reliability of postmortem-specific IgE antibody testing in venom anaphylactic death and the range of antibody levels found. Radioallergosorbent testing was performed on sera from three groups: 51 anaphylactic deaths from insect stings, 20 anaphylactic/anaphylactoid deaths from food and drugs, and 31 control subjects. Results were analyzed by descriptive statistics, chi-squared test, and receiver operating characteristic curve. The sera in the sting death group were significantly different from the other two groups, which were not statistically different from each other. The maximal sensitivity of the radioallergosorbent test was 90% at 0.35 ng/mL, and the optimal sensitivity was 73% with a specificity of 86% at 0.54 ng/mL. IgE antibody could not be detected in 10% of the sting death sera and levels from 0.35 to 0.65 ng/mL were found in 24%. The level of specific IgE antibodies against venoms is not predictive of the severity of anaphylactic reaction.