Medical and pathologic characteristics of fatal anaphylaxis: a Spanish nationwide 17-year series

  • Pilar Martínez-Fernandez
  • Gloria Vallejo-de-Torres
  • M. Soledad Sánchez-de-León-Robles
  • Esperanza Navarro-Escayola
  • Mar Moro-Moro
  • Nuria Alberti-Masgrau
  • Miguel A. Tejedor-AlonsoEmail author
Original Article


Forensic series on fatal anaphylaxis are scarce, probably because the diagnosis of anaphylaxis is often complex and the incidence is low. We report on the medicolegal, demographic and histopathological characteristics of a series of sudden deaths which were investigated for anaphylaxis at the Spanish National Institute of Toxicology and Forensic Sciences (INTCF) over a 17-year period (1998–2015). A total of 122 undetermined sudden deaths from a high percentage of Spanish regions (81.5% of the total population) were sent to the INTCF with anaphylaxis as the suspected cause of death for histological, biochemical, and medicolegal investigation. Two certified allergists confirmed that 46 of the 122 cases were fatal anaphylaxis. The results indicated a median age of 51 years (IQR = 29) and a male predominance (76%). The main causes of anaphylaxis were drugs (41%), hymenoptera stings (33%), and food (13%). A previous allergic event had been reported in both food anaphylaxis (67%) and drug anaphylaxis (53%). The deaths occurred in health care settings (37%), at home (22%), and outside the home (26.09%). Histopathology data were available for 40 individuals. The most frequent autopsy findings were angioedema of the upper airways (50%), pulmonary edema (47.5%), atheromatosis of coronary vessels (32.5%), and pulmonary congestion (27.5%). Our findings for fatal anaphylaxis indicated a predominance of men, older age (≥50 years) and death in a health care setting (one-third of cases). Previous episodes had occurred in two-thirds of cases of food-induced anaphylaxis and in half of the cases of drug-induced anaphylaxis.


Anaphylaxis Deaths Pathologic Medicolegal Demographic Causes 



The authors thank Dr. Beatriz Aguilera from the Histopathology Department at the INTCF for her valuable histological casework and Thomas O’Boyle for proofreading the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

The study was approved by the Research Committee and the Clinical Research Ethics Committee of University Hospital Fundación Alcorcón (number 17/103).

Informed Consent

Given the retrospective design of the study, formal consent was not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Pilar Martínez-Fernandez
    • 1
  • Gloria Vallejo-de-Torres
    • 1
  • M. Soledad Sánchez-de-León-Robles
    • 1
    • 2
  • Esperanza Navarro-Escayola
    • 3
    • 4
  • Mar Moro-Moro
    • 5
  • Nuria Alberti-Masgrau
    • 6
  • Miguel A. Tejedor-Alonso
    • 5
    • 7
    Email author
  1. 1.Biology ServiceNational Institute of Toxicology and Forensic Science (INTCF)MadridSpain
  2. 2.INTCF Histopathology ServiceLas Rozas de MadridSpain
  3. 3.Instituto Medicina Legal y Ciencias ForensesAlicanteSpain
  4. 4.Sección LaboratorioInstituto Medicina Legal de AlicanteAlicanteSpain
  5. 5.Allergy UnitHospital Universitario Fundación AlcorcónMadridSpain
  6. 6.Pathology DepartmentHospital Universitario 12 de OctubreMadridSpain
  7. 7.Medicine and Surgery Area, Facultad Ciencias de la SaludUniversidad Rey Juan CarlosMadridSpain

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