Autopsy Manifestations of Deaths Suspected of Acute Allergic Reactions

Abstract

Aims: To outline the prevalence of postmortem manifestations of anaphylaxis at necropsy after suspected fatal acute allergic reaction.
Materials and Method: Data were registered from archives at the Medico-legal Directorate, ten cases were examined within two years from January 2021 to January 2023, seven males and three females with age a group in between 5-75 years, and average was forty years. Mast cell tryptase (MCT) was measured in laboratories of both Medico-Legal Directorate and Baghdad Medical City. Further information were gathered from histopathological assessment, witnesses at the scene, police report with suspected positive family or personal history of drug allergy.
Results: All ten victims gave a past history of fainting after contracting with allergen. All patients have had a respiratory problem in their life. Most victims passed away within one hour of acute allergic reaction (seven victims developed sudden rapid deaths) and delayed in three cases (up to one month).All cases have had previous allergic reaction to drugs. Iatrogenic reactions were seen in four cases. Five cases gave history of penicillin intake, three with NSAIDS (Nonsteroidal anti-inflammatory drugs) and two with combination drugs intake. Most drugs were given by intramuscular way (five patients), three with intravenous and two with oral routes. Most patients died without obvious reason. Lung swelling and congestion both were the most common finding in all necropsies.
Conclusion: Most cases of deaths related to suspected acute allergic reaction present with no diagnostic cutline signs and symptoms at necropsy specially if anaphylactic .The absence of specific signs and symptoms of allergic reaction or negative clinical history does not deny the presence of fatal allergic reaction.