Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients.

Abstract

BACKGROUND:

The diagnosis of anaphylaxis is based on clinical history since no reliable biological marker is currently available to confirm the diagnosis.

OBJECTIVE:

It was the aim of this study to determine sequential serum tryptase concentrations during anaphylaxis and to evaluate its potential as a diagnostic marker.

METHODS:

We performed a prospective study including patients with acute anaphylaxis (according to the National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria) attending the emergency department. Demographic characteristics, anaphylactic triggers, specific risk factors, clinical characteristics and management of anaphylaxis were recorded. Serum tryptase was measured at 1-2 h (T1), 4-6 h (T2) and 12-24 h (T3) following onset of the episode and at basal conditions (TB).

RESULTS:

A total of 102 patients were included (63 females, mean age 47.4 ± 19.1 years). Tryptase concentration at T1 (19.3 ± 15.4 µg/l) was significantly higher than at T2, T3 and TB (all <11.4 µg/l; p < 0.0001). Importantly, tryptase was not raised in 36.3% of cases; furthermore, in 60.6% of these patients, no changes were observed in tryptase levels comparing T1 and TB (ΔT1-TB = 0). Tryptase was more frequently elevated in more severe anaphylaxis (p < 0.0001) and positively correlated with the grades of severity (p < 0.001, r = 0.49). Anaphylaxis was more severe and tryptase concentration higher when the causative agent was a drug compared to food, both at T1 (p = 0.045) and at TB (p = 0.019). Age and coronary risk factors were associated with more severe anaphylaxis (p = 0.001).

CONCLUSION:

Tryptase is a biomarker related to the severity of anaphylaxis. However, since its concentration remains unaltered in a considerable number of patients during acute anaphylaxis, there is a need for more reliable diagnostic biological tests.

• Authors: Anna Sala-Cunill, Victoria Cardona, Moises Labrador-Horrillo, Olga Luengo, Olga Esteso, Teresa Garriga, Maria Vicario, Mar Guilarte
• Journal: International archives of allergy and immunology (Int Arch Allergy Immunol) Vol. 160 Issue 2 Pg. 192-9 ( 2013) ISSN: 1423-0097 [Electronic] Switzerland
• PMID: 23018683 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 S. Karger AG, Basel.

Chemical References

• Biomarkers
• Tryptases

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anaphylaxis (blood, diagnosis)
• Biomarkers (blood)
• Female
• Humans
• Male
• Middle Aged
• Tryptases (blood)
• Young Adult