Serum Baseline Tryptase Level as a Marker for the Severity of Anaphylaxis

Abstract

Background: Anaphylaxis is a severe and potentially fatal allergic disease or hypersensitivity reaction with variable clinical presentation. Biomarkers in anaphylaxis could be useful to improve diagnosis, to allow endotyping of patients, and to predict risk. Objective: To investigate the role of serum basal tryptase (sBT) levels in the management of patients with anaphylaxis. Methods: Patients with at least 1 episode of anaphylaxis were selected among those who attended the Allergy Clinics of the Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, Brazil, upon evaluation by allergy/immunology specialists of our medical staff. Demographic and clinical data were obtained using a structured questionnaire. sBT levels were determined using the ImmunoCAP Tryptase immunoassay. Results: 57 patients (56.1% female) with a median age of 35 years (range 7–87 years) participated in the study. sBT levels ranged from 2.57 to 21.19 ng/mL (mean 5.17 ng/mL), with no significant differences in patients with anaphylaxis due to different triggers. Mean levels were 4.93; 5.2; 5.41, and 5.24 ng/mL for patients who had anaphylaxis due to Hymenoptera venom (n = 17), foods (n = 13), drugs (n = 13), and idiopathic disease (n = 14), respectively. Significantly higher sBT levels were observed in patients with severe anaphylaxis (grade IV) than in patients with mild-moderate disease (grades II/III) (mean levels 6.61 vs. 4.71 ng/mL, respectively). Conclusion: High sBT levels may help to identify patients at increased risk of more severe anaphylaxis, prompting physicians to initiate immediate therapy to avoid further acute episodes.

Higher basal tryptase, asthma and loss of consciousness in anaphylaxis are associated with biphasic reactions

“…For asthma patients, basal tryptase level was significantly higher for those with biphasic than monophasic anaphylaxis (median: 5.3 μg/l, n = 6 vs 3.7 μg/l, n = 38, p=0.015). This is the first study to suggest that basal tryptase level was higher with biphasic than monophasic anaphylaxis and we know that higher tryptase level is associated with severity of anaphylaxis (1,4). This association needs to be confirmed in futures studies to conclude that higher basal tryptase could be a risk factor for severe anaphylaxis like biphasic reactions.…”

Refractory Anaphylaxis: Data From the European Anaphylaxis Registry

“…BST may reflect pro-β tryptase due to increased body mast cell content (18) or result from alpha-tryptasemia due to multiple copies of TPSAB1 gene (19). Irrespective of the mechanism—increased BST has been shown to correlate with the severity of anaphylaxis (20).…”

Higher basal tryptase, asthma and loss of consciousness in anaphylaxis are associated with biphasic reactions

“…This is the first study to suggest that basal tryptase level was higher with biphasic than monophasic anaphylaxis and we know that higher tryptase level is associated with severity of anaphylaxis. 1 , 4 This association needs to be confirmed in futures studies to conclude that higher basal tryptase could be a risk factor for severe anaphylaxis like biphasic reactions. The increased proportion of asthma patients in the biphasic group might be an explanation.…”

“…Terence Langlois 1,2 Pascale Nicaise-Roland 3,4 Camille Taillé 1,4 Patrick Natta 1 Bruno Crestani 1,4 Sylvie Chollet-Martin 3,5 Luc de Chaisemartin 3,5 Catherine Neukirch…”