Anaphylactic deaths are frequently observed at autopsies. Since death associated with medical practice has become social concern, the identification of anaphylactic shock is an important part of forensic medicine. However, autopsy findings of anaphylactic shock are usually non-specific; therefore, the diagnosis of anaphylactic shock must be inferred from collecting data on the past history of the deceased, circumstances of death, and negative autopsy findings. The analysis of serum mast cell tryptase level is a well-known, useful ancillary test for the diagnosis of anaphylactic shock, but is not widely used in daily practice in Korea. We recently encountered 2 autopsy cases of anaphylactic shock and confirmed that analysis of serum mast cell tryptase level was useful for the diagnosis of anaphylactic shock. In this report, we present these 2 autopsy cases of anaphylactic shock, with literature review of the usefulness and limitations of serum mast cell tryptase analysis.