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While at work in a vineyard, the man suffered a serious anaphylactic crisis and cardiovascular arrest; despite ongoing attempts of resuscitation, he died in hospital 12\u00a0h after being stung. Autopsy confirmed that death was due to post-anoxic brain damage, cardiovascular shock, disseminated intravascular coagulation (DIC) and multi-organ failure (MOF). ICU blood samples drawn before the patient\u2019s death from the distal extremity of the pulmonary catheter revealed central blood tryptase levels of 8955 ng\/mL; samples drawn 6 days after death, at autopsy, confirmed anaphylaxis diagnostic central blood total tryptase levels (4977 ng\/mL) and peripheral blood levels (319 ng\/mL); IgE levels in ICU blood sample suggested that the farmer was a responder to venom immunoteraphy (VIT) for\n                    <jats:italic>Apis Mellifera<\/jats:italic>\n                    (IgE 0.44 kUI\/L) but not for\n                    <jats:italic>Polistes Dominulus<\/jats:italic>\n                    (IgE 3.13 kUI\/L) yet. The comparison of perimortem laboratory results was crucial, in association with autopsy findings and circumstantial data, in ascertaining that death was caused by a wasp venom anaphylactic reaction, with key findings being: 1) Significantly high pre-mortem (8955 ng\/mL) and post-mortem (4977 ng\/mL) central blood tryptase levels. 2) High post-mortem peripheral blood tryptase levels (319 ng\/mL). 3) High pre-mortem central blood IgE antibodies against\n                    <jats:italic>Polistes Dominulus<\/jats:italic>\n                    .\n                  <\/jats:p>","DOI":"10.1007\/s00414-025-03487-1","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T03:27:15Z","timestamp":1743737235000},"page":"1903-1911","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fatal anaphylactic shock due to hymenoptera venom in a farmer suffering from indolent systemic mastocytosis. The comparative diagnostic relevance of perimortem serum tryptase levels"],"prefix":"10.1007","volume":"139","author":[{"given":"Ugo Da","family":"Broi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Simonit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Perogio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Visentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Reccardini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rexson","family":"Tse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Garland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Ondruschka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Desinan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"3487_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.forsciint.2010.04.039","volume":"204","author":"U Da Broi","year":"2011","unstructured":"Da Broi U, Moreschi C (2011) Post-mortem diagnosis of anaphylaxis: A difficult task in forensic medicine. 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Am J Forensic Med Pathol 25(1):37\u201343. https:\/\/doi.org\/10.1097\/01.paf.0000113814.56572.de","journal-title":"Am J Forensic Med Pathol"}],"container-title":["International Journal of Legal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-025-03487-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00414-025-03487-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-025-03487-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:04:38Z","timestamp":1750032278000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00414-025-03487-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["3487"],"URL":"https:\/\/doi.org\/10.1007\/s00414-025-03487-1","relation":{},"ISSN":["0937-9827","1437-1596"],"issn-type":[{"value":"0937-9827","type":"print"},{"value":"1437-1596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]},"assertion":[{"value":"11 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All postmortem examinations referred to this Department were ordered by the Public Prosecutor\u2019s Office and, in compliance with current Italian legislation, the ethical approval was waived because all autopsy data were part of the Prosecutor\u2019s investigations and anonymously evaluated.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Publish"}}]}}