Postmortem diagnostics of assumed food anaphylaxis in an unexpected death

Diagnosis of lethal anaphylaxis is known to be difficult to establish in forensic autopsy. Cases of anaphylactic shock have to be dealt with in forensic medicine comparatively frequently as death due to anaphylaxis is likely to occur rapidly and without warning in seemingly healthy subjects. Autopsy findings might hint at allergic reaction, but classic manifestations can also be completely absent. A case of suspected food anaphylaxis in a middle-aged woman is presented. The deceased had been known to suffer from multiple allergies. Death came about after an evening meal with friends. Dyspnoea was reported to have been followed by collapse, unconsciousness and death within minutes. The course of further analysis undertaken (toxicology, biochemistry, immunohistochemistry) is examplarily described. By means of the results presented we discuss problems and possibilities of postmortem diagnostics of food induced anaphylaxis.