Studies in stinging insect hypersensitivity: postmortem demonstration of antivenom IgE antibody in possible sting-related sudden death.

The purpose of this study was to extend previous findings of elevated antivenom IgE antibodies in sera from persons experiencing fatal insect sting reactions. Elevated IgE antibodies to at least one venom were measured in sera from four of six witnessed fatal cases of sting anaphylaxis; in one of two unwitnessed cases of sudden, unexpected death in which the circumstances suggested possible sting anaphylaxis; and in one unwitnessed death where autopsy findings of massive swelling of the pharynx and larynx suggested anaphylaxis. Conversely, no elevated IgE antibodies were measured in serum from a boy who received more than 40 yellow jacket stings with subsequent cardiopulmonary arrest, from which he was successfully resuscitated. Measurement of IgE antibodies in postmortem sera may not only provide confirmatory evidence of fatal anaphylaxis following witnessed insect stings, but also may provide useful additional data in unwitnessed deaths where the clinical history or autopsy findings suggest unexplained anaphylaxis.