Mast Cell Activation During Suspected Perioperative Hypersensitivity: A Need for Paired Samples Analysis
Abstract
Background Perioperative hypersensitivity (POH) reactions constitute a significant clinical and diagnostic challenge. A transient increase in serum tryptase during POH reflects mast cell activation (MCA) and helps to recognize an underlying hypersensitivity mechanism.Objective To determine the diagnostic performance of different tryptase decision thresholds based on single and paired measurements to document MCA in suspected POH.Methods Acute serum tryptase (aST) and baseline serum tryptase (bST) samples were obtained from patients referred to our outpatients clinic because of clinical POH. Tryptase samples from controls were obtained before induction (Tt 0) and 1.5 hours after induction (Tt 1) in uneventful anesthesia. Different cutoff points for tryptase increase over bST and the percentage increase in tryptase (%T) were calculated and compared with existing thresholds: aST > [1.2 × (bST) + 2] (consensus formula), aST higher than 11.4 ng/mL, and aST higher than 14 ng/mL.Results Patients with POH had higher bST and aST levels compared with controls (respectively 5.15 vs 2.28 ng/mL for bST and 20.30 vs 1.92 ng/mL for aST). The consensus formula and a tryptase increase over bST of greater than or equal to 3.2 ng/mL held the highest accuracies to document MCA in POH (respectively 81% and 82%). A bST of higher than 8 ng/mL was present in 4% of controls, 5% of patients with grade 1 POH, 24% of patients with grade 2 POH, 15% of patients with grade 3 POH, and 17% of patients with grade 4 POH.Conclusions Our data endorse the consensus formula for detection of MCA in POH. Furthermore, it shows that a bST of higher than 8 ng/mL was associated with occurrence of anaphylaxis.
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In perioperative anaphylaxis, the consensus formula showed the best sensitivity and specificity.
“In perioperative anaphylaxis, the consensus formula showed the best sensitivity and specificity [11].”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [11]
Tryptase is a useful and specific marker to demonstrate mast cell activation and degranulation when an acute value (within 4 h after the event) and a baseline value (at least 24 h after the event) are compared and meet the consensus formula (increase of 20% + 2).
“Tryptase has proven to be a very useful and specific marker to demonstrate mast cell activation and degranulation when an acute (i.e., within 4 h after the event) and baseline value (i.e., at least 24 h after the event) are compared and meet the consensus formula (i.e., an increase of 20% + 2).”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [11]
According to the consensus formula, an acute serum tryptase (aST) ≥ [(1.2 × baseline serum tryptase (bST)) + 2] depicts mast cell activation (MCA).
“According to the consensus formula, an aST ≥ [(1.2 × bST) + 2], depicts MCA [10,11].”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [11]
An increase in tryptase > 20% + 2 during an acute event is a required criterion in the diagnosis of mast cell activation syndrome.
“A tryptase > 20 ng/mL serves as a minor criterion to diagnose systemic mastocytosis and an increase in tryptase > 20% + 2 during an acute event is a required criterion in the diagnosis of mast cell activation syndrome.”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [11]
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Ebo, D. G., Peeters, L., Toscano, A., Elst, J., Mertens, C. H., Houdt, M. V., Hagendorens, M. M., Beyens, M. M. J., Saldien, V., & Vlaeminck, N. (2026) · Current Allergy and Asthma Reports · doi:10.1007/s11882-026-01296-z
- Authors
- Ebo, D. G., De Puysseleyr, L. P., Van Gasse, A. L., Elst, J., Poorten, M.-L. V. D., Faber, M. A., Mertens, C., Van Houdt, M., Hagendorens, M. M., Sermeus, L., Vitte, J., Moise, M., Garvey, L. H., Castells, M. C., Tacquard, C., Mertes, P.-M., Schwartz, L. B., & Sabato, V.
- Affiliations
- University of Antwerp (BE)
- Antwerp University Hospital (BE)
- Inserm (FR)
- Aix-Marseille Université (FR)
- Gentofte Hospital (DK)
- Brigham and Women's Hospital (US)
- Hôpitaux Universitaires de Strasbourg (FR)
- Virginia Commonwealth University (US)
- Corresponding author
- Ebo, Didier G.
- ORCID
- Venue
- The Journal of Allergy and Clinical Immunology In Practice
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 9
- Issue
- 8
- Pages
- 3051-3059.e1
- ISSN
- 2213-2198 (ISSN-L)
- OpenAlex
- W3156075484
- Cited by
- 26
- References
- 55
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 3
- FWCI
- 2.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Keywords
- mast cell activation, serum tryptase, anaphylaxis, anesthesia, diagnostic accuracy
- MeSH terms
- Anaphylaxis, Humans, Mast Cells, Tryptases
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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