The effectiveness and safety of drug treatment are the main criteria for its success. Local anesthetics, used in all medical fields, in some cases can cause a wide variety of undesirable side reactions, but in recent years, such manifestations that have arisen in Russian clinical practice tend to qualify as anaphylactic shock. This article presents the types of adverse reactions and global statistics of anaphylaxis to local anesthetics, as well as analyzes the possible reasons for the erroneous diagnosis of fatal outcomes of anaphylaxis. The purpose of the review was to clarify information about reliable markers of clinical and postmortem anaphylaxis, providing unambiguousness and objectivity of forensic medical examination. Attention is focused on the specific postmortem signs of immediate allergic reactions and the sequence of professional interpretation of all the circumstances associated with a fatal adverse reaction against the background of the use of local anesthetics.