“…(2) the analysis of histamine levels is not reliable at postmortem because its rapid metabolism; (3) total and specific IgE levels, although stable for weeks postmortem, may be absent in people suffering from anaphylaxis; (4) tryptase (upper limit for living subjects 11.4 μg/L) whose levels are generally stable for some days after death (postmortem cutoff of 23 μg/L was recently determined by Garland et al in cases of nonanaphylactic death) may be within normal limits even in cases of fatal anaphylactic shock; (5) tryptase levels are affected by numerous factors (such as postmortem interval, hemolysis, resuscitation procedures, trauma, acute cardiovascular disease, bacterial/viral infections, drug overdose, sudden infant death syndrome, mastocytosis). 13,79,80,[88][89][90][91][92][93][94][95][96][97][98][99] Therefore, the levels of the analytes currently in use, such as tryptase and total/specific IgE, should always be carefully interpreted in the context of the wider clinical history, symptoms, and postmortem findings. 13,79,80,[88][89][90][91][92][93][94][95][96][97][98][99] Studies of biphasic anaphylaxis make it clear that the second reaction, especially cases where death results, often appears around an hour after the primary reaction.…”