Diagnostic Value of Serum Baseline Tryptase Levels in Childhood Asthma and Its Correlation with Disease Severity

Abstract

Background: The aim of this study was to explore whether serum baseline tryptase (sBT) levels might be a useful marker not only for the accurate diagnosis of childhood asthma, but also for the prediction of disease severity. Methods: A total of 114 asthmatic children were enrolled in this study, 36 of whom had mild intermittent asthma, 38 had mild persistent asthma, and 40 had moderate to severe persistent asthma. Additionally, 34 age-matched healthy children were enrolled as controls. The sBT levels of these populations were measured using a fluoroenzymeimmunoassay kit. The diagnostic performance of sBT levels and their correlation with asthma severity were systematically investigated using receiver operating characteristic (ROC) analysis and correlation analysis. Results: Children with mild and moderate to severe persistent asthma had significantly increased sBT levels as compared to those with mild intermittent asthma and healthy controls. ROC analysis further demonstrated that sBT levels not only appear to be highly sensitive and specific for distinguishing asthmatic children from healthy controls, but also show good accuracy for the differentiation of various asthmatic subgroups. Correlation analysis revealed that in all asthmatic subgroups sBT levels were significantly correlated with a variety of key markers that reflect the disease severity of asthma, including childhood asthma control test scores, serum IgE and interleukin-13 levels, blood eosinophil counts, and pulmonary test parameters. Conclusions: sBT levels may have a potential use in supporting a diagnosis of asthma in children and as a predictor of disease severity.

Mast Cells and Their Progenitors in Allergic Asthma

“…One cluster consisted of asthma patients with severe asthma who were generally older, had high BMI, poor lung function and many symptoms, while the other group consisted predominately of patients who were female, obese, non-atopic, had later onset and poor lung function. In children, basal serum tryptase levels were higher in those with mild, moderate or severe persistent asthma than in those with mild intermittent asthma and healthy controls (192). Nevertheless, more studies are needed to clarify the importance of mast cell tryptase and the mechanisms behind its role in allergic and non-allergic asthma.…”

The emerging role of mast cell proteases in asthma

“…This possibility has been explored in several studies focusing on measurements of serum tryptase. In one study it was shown that children with mild and moderate to severe asthma had higher serum tryptase levels in comparison with children with mild intermittent asthma and healthy controls [41]. Moreover, serum tryptase levels could be used to predict disease severity [41].…”

Blood tryptase and thymic stromal lymphopoietin levels predict the risk of exacerbation in severe asthma

“…Only 15% of the study subjects had positive bronchodilator reversibility and 7% of the patients received maintenance oral corticosteroids. The median score of ACT was 21 (19)(20)(21)(22)(23), 70% of which were de ned as uncontrolled asthma at the commencement of the study.…”

“…Tryptase is a speci c marker of mast-cell activation, and thus tryptase levels can be reasonably measured to re ect the burden of mast cell activation in the allergic T H 2 pathway in asthma 19,32 . Gao et al 20 reported that serum baseline tryptase levels in childhood asthma, as well as asthma control, serum IgE and IL-13 levels, blood eosinophil counts, and lung function parameters, are strongly correlated with disease severity of asthma. The Severe Asthma Research Program also reported that severe asthma is associated with the predominance of tryptase+chymase+mast cells in the airway submucosa and epithelium 33 .…”

“…As the major protein component in the mast cells, tryptase has been recognized as a speci c marker of mast cell activation and involved in allergic asthm 19 . Serum tryptase can be used to predict disease severity in childhood asthma 20 . In induced sputum, tryptase concentration can be reduced by high doses of inhaled corticosteroid (ICS) within 6 h in symptomatic asthmatics 21 .…”