Diagnostic value of tryptase in anaphylaxis

Sala-Cunill A, Cardona V, Labrador-Horrillo M, Luengo O, Esteso O, Garriga T, Vicario M, Guilarte M. Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients. Int Arch Allergy Immunol. 2013;160(2):192-9.

“Nowadays, serum tryptase concentration is the most used laboratory test to confirm anaphylaxis. According to current knowledge, tryptase is the best biomarker to assess mast cell activation. Levels are increased from 15 min to 3 h after anaphylaxis onset [4,6]. Although an elevated tryptase concentration supports this diagnosis, failure to document an elevation does not refute anaphylaxis. This is true even if the blood sample has been obtained adequately, and especially in cases of food-induced anaphylaxis where tryptase often remains low [7]. Serial measurements of total serum tryptase have been shown to increase the sensitivity and specificity of the test [8,9]. Also, measurement of tryptase at baseline, obtained at least 24 h after resolution of symptoms, has been recommended in ascertaining whether or not anaphylaxis has occurred [8].

Therefore, the aim of our study was to determine sequential serum tryptase concentration in patients with anaphylaxis, both during the acute episode and at baseline, and to evaluate its usefulness in the diagnosis of anaphylaxis and as a marker related to the clinical severity of the reaction.”

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Vadas P, Perelman B, Liss G. Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis. J Allergy Clin Immunol. 2013 Jan;131(1):144-9.

(Comment in: Serum tryptase determination in patients with acute allergic reactions. J Allergy Clin Immunol. 2013. Emory access.)

“The PAF level was significantly elevated in proportion to the severity of acute allergic reactions. Whereas the PAF level was elevated in all patients with severe anaphylaxis, this was not true for either histamine or tryptase. Neither histamine nor tryptase showed as good correlations with severity scores as did PAF. These data are consistent with a pivotal role for PAF as a mediator of anaphylaxis.”

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Michalska-Krzanowska G. Tryptase in diagnosing adverse suspected anaphylactic reaction. Adv Clin Exp Med. 2012 May-Jun;21(3):403-8.

“Determination of serum mast cell tryptase (MCT) is becoming more widely used in diagnosing allergic reactions involving mast cells. It can help evaluate the allergenic effects of drugs administered during anesthesia and the perioperative period. Until now, data about the role of tryptase in the body has not been clarified yet. Patients with elevated MCT levels should undergo further testing to find out the causative agent of a potential allergic reaction. Patients with normal tryptase concentration should also undergo further diagnosis if they manifest clinical symptoms of a severe anaphylactic reaction.”

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Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006 Aug;26(3):451-63.

“Serum (or plasma) levels of total and mature tryptase measurements are recommended in the diagnostic evaluation of systemic anaphylaxis and systemic mastocytosis, but their interpretation must be considered in the context of a complete workup of each patient. Total tryptase levels generally reflect the increased burden of mast cells in patients with all forms of systemic mastocytosis (indolent systemic mastocytosis, smoldering systemic mastocytosis, systemic mastocytosis associated with a hematologic clonal non-mast cell disorder, aggressive systemic mastocytosis, and mast cell leukemia) and the decreased burden of mast cells associated with cytoreductive therapies in these disorders. Causes of an elevated total tryptase level other than systemic mastocytosis must be considered, however, and include systemic anaphylaxis, acute myelocytic leukemia, various myelodysplastic syndromes, hypereosinophilic syndrome associated with the FLP1L1-PDGFRA mutation, end-stage renal failure, and treatment of onchocerciasis. Mature (beta) tryptase levels generally reflect the magnitude of mast cell activation and are elevated during most cases of systemic anaphylaxis, particularly with parenteral exposure to the inciting agent.”

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More PubMed results for tryptase and anaphylaxis.

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