Death in anaphylaxis in a man with house dust mite allergy

Abstract

Up to recently the post-mortem diagnosis of anaphylaxis has been based solely on circumstantial evidence. With the development of assays for mast cell tryptase it is now possible to verify cases of suspected anaphylaxis. Here we present one such case, which initially appeared to be due to sudden death of unknown cause. A 47-year-old farmer was found dead in his bathroom around midnight. Hospital records revealed that he had previously been diagnosed with an allergy to house dust mites. He had also had infrequent episodes of airway symptoms, nausea, hypotension and diarrhoea usually after going to bed. The forensic autopsy did not give any clue to the cause of death. Serum tryptase in post-mortem blood was found to be substantially elevated in two samples (170 and >200 microg/L). Analysis of allergen-specific IgE showed high values for Dermatophagoides pteronyssinus and farinae. High mite allergen levels were found in dust obtained from the patient's mattress. The results of the immunological tests support the assumption that he died of anaphylactic shock. The circumstances and the patient's history of previous attacks after going to bed point to the fact that exposure to mite contaminated food and/or exposure to mite allergens in bed might have caused his death.

House dust mite-related allergic diseases: role of skin prick test, atopy patch test, and RAST in the diagnosis of different manifestations of allergy

“…The most frequently responsible mites are Dermatophagoides pteronyssinus and Dermatophagoides farinae which produce efficient allergens able to induce sensitization and clinical disease [38]. The spectrum of allergic manifestations includes atopic dermatitis (AD) [35], which is particularly frequent in children, rhinitis and asthma [13,26], and, very rarely, anaphylaxis [10]. The knowledge of the mechanisms underlying the kind of sensitization and the type of clinical expression is far from exhaustive.…”

Usefulness of serum mast cell–specific chymase levels for postmortem diagnosis of anaphylaxis

“…1). Considering the usefulness of seum tryptase levels for diagnosis of anaphylaxis [8][9][10][11][12], serum chymase levels might be an additional diagnostic tool.…”

“…Since tryptase is released from the granules at the onset of anaphylactic events, serum tryptase levels are considered a reliable indicator of anaphylaxis [8][9][10]. Furthermore, measurement of serum tryptase levels is known to be useful for postmortem diagnosis of anaphylaxis, because of its long serum half-life compared with other chemical mediators like histamine [11,12].…”

Black oesophagus: a rare disorder with potentially fatal outcome

“…The investigation of sudden, unexpected death is an important and challenging issue in medico-legal autopsy practice, occasionally placing heavy demands on the forensic pathologist to provide satisfactory answers to the investigating authorities in specific cases [2,3,5,9,10,20,33]. Apart from Mallory-Weiss syndrome and ruptured oesophageal varices [33], acute necrotising oesophagitis has been described as the source of fatal upper gastrointestinal bleeding in association with carcinoma of the oesophagus [1,29] and after medications had failed to transit the oesophagus and acted locally ultimately producing necrotising oesophagitis [18].…”