Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients

Sala‐Cunill, Anna; Cardona, Victòria; Labrador‐Horrillo, Moisés; Luengo, Olga; Esteso, Olga; Garriga, Teresa; Vicario, María; Guilarte, Mar

doi:10.1159/000339749

Cited by 162 publications

(129 citation statements)

References 63 publications

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“…In a prospective study in adults, serum total tryptase concentrations were measured sequentially 1-2, 4-6, and 12-24 h after the onset of anaphylaxis symptoms and at baseline (follow-up). In 62% of the patients, initial tryptase levels were elevated (mean 19.3 ± 15.4 μg/l) with positive correlation between grades of severity and tryptase levels (p < 0.001, r = 0.49) [48]. …”

Section: Clinical Diagnosismentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

247

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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Section: Clinical Diagnosismentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

247

181

View full text Add to dashboard Cite

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“…Baseline measurements are useful for allowing comparison to acute measurements, therefore enhancing diagnostic capacity. Although anaphylactic reactions to intravenous drugs have been shown to elicit greater increases in tryptase levels than oral triggers such as foods [13], our observational study has not identified significant differences in sBT levels and the types of triggers involved, but sBT levels were significantly higher among patients with more severe anaphylaxis. Our results are in keeping with those of Sahiner et al [23], who showed the relevance of sBT levels in predicting the risk of anaphylaxis in food allergy: a cutoff of 5.7 ng/mL was associated with a 50% probability of moderate-severe anaphylaxis.…”

Section: Discussionmentioning

confidence: 64%

“…The use of tryptase measurement for the diagnosis of anaphylaxis is well established [13, 15, 22]. However, one single acute measurement of the tryptase level may not be decisive to establish the correct diagnosis of anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

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

Aniceto

Dias

Melo

et al. 2019

Int Arch Allergy Immunol

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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.

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“…Normal tryptase levels do not exclude the possibility of anaphylaxis, which can remain normal in 36% of patients who had clinically defined anaphylaxis. 31 A possible explanation is anaphylaxis attributed to local release of tryptase (e.g. in laryngeal oedema), which may not be sufficient to increase the total serum tryptase concentration; alternatively, there may be a greater participation of basophils than mast cells in the mechanism of anaphylaxis in some situations.…”

Section: Norwaymentioning

confidence: 99%

Anaphylaxis during general anaesthesia: experience from a drug allergy centre in theUK

Meng

Rotiroti

Burdett

et al. 2017

Acta Anaesthesiol Scand

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BackgroundAnaphylaxis during general anaesthesia is rare but often severe. Identification of the cause of anaphylaxis and recommendation of a range of drugs or agents likely to be safer for future surgery is a collaborative venture between the allergists and the anaesthesiologists, but it often poses a significant challenge.MethodsA total of 31 patients who attended the Drug Allergy Unit at University College London Hospital with suspected perioperative anaphylaxis between March 2013 and January 2016 were reviewed retrospectively.ResultsThe culprit drug was identified in 21 patients (67.7%): antibiotics (n = 11, 52.3%), neuromuscular blocking agents (n = 8, 38.1%), morphine (n = 1, 4.8%) and gelofusine (n = 1, 4.8%). No cause was identified in six patients (19.4%), and four patients (12.9%) had non‐allergic reactions.ConclusionOur results confirm that antibiotics and neuromuscular blocking agents are common causative agents of perioperative anaphylaxis in the United Kingdom.

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Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients

Cited by 162 publications

References 63 publications

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

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

Anaphylaxis during general anaesthesia: experience from a drug allergy centre in theUK

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