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Cited by 27Mast cells and histamineAsthma and respiratory diseasesFood Allergy and Anaphylaxis Research

Nontryptase urinary and hematologic biomarkers of mast cell expansion and mast cell activation: status, 2022

Butterfield, J.H.·2022·The Journal of Allergy and Clinical Immunology: In Practice
DOI 10.1016/j.jaip.2022.03.008
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Abstract

Quantitation of urinary metabolites of histamine, prostaglandin D 2, and leukotriene E 4 can fill the gap in our current efforts to improve diagnosis and management of symptomatic patients with systemic mastocytosis, and/or mast cell activation syndrome, In addition, patients symptomatic due to mast cell activation but who do not meet all the criteria for mast cell activation syndrome can have elevated baseline mediator metabolites. Serum tryptase levels have been the workhorse in diagnosing these disorders, but it has several drawbacks including the need to obtain acute and baseline samples, which require 2 visits to health care facilities and 2 venipunctures. Recently, increased baseline tryptase level has been reported in hereditary alpha tryptasemia, complicating diagnostic possibilities of an increased baseline tryptase level. Furthermore, no treatment can specifically be targeted at tryptase itself. In contrast, the finding of 1 or more elevated urinary levels of histamine, prostaglandin D 2, and/or leukotriene E 4 metabolites (1) greatly narrows diagnostic possibilities for causes of symptoms; (2) informs the practitioner what specific metabolic pathways are involved; and (3) targets the treatment in a specific, direct fashion. As a bonus, baseline spot/random urine samples can be obtained by the patients themselves and repeated at exactly the correct time when symptoms occur.

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Crossref · 10.1016/j.jaip.2022.03.008

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119 of 119 references verified0 citation errors · 0 not checkable

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  • Other mediators such as platelet-activating factor (PAF), prostaglandin D2, leukotriene E4, histamine, or other cytokines might be more sensitive in patients with food-induced anaphylaxis.

    “It is possible that other mediators such as platelet-activating factor (PAF), prostaglandin D2, leukotriene E4, histamine, or other cytokines might be more sensitive in these patients [34,35,36,37].”

    From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [35]

  • Proposed thresholds for increases above baseline include urinary N-methylhistamine >400 μg/g Cr and 11β-PGF2α >3500 ng/d.

    “Recently a range has been proposed for increases above baseline and includes urinary N-methylhistamine >400 μg/g Cr and 11β-PGF2α>3500 ng/d.21”

    From Mast cell activation syndrome: Current understanding and research needs (2024) · cites this paper as [21]

  • Advantages of urine testing include real-time collection and at-home performance without relying on acute care facilities.

    “Advantages of urine testing include real-time collectionand all diagnostic MCAS criteria are fulfilled and at-home performance, without relying on acute care facilities.21”

    From Mast cell activation syndrome: Current understanding and research needs (2024) · cites this paper as [21]

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Authors
Butterfield, J. H.
Affiliations
Mayo Clinic (US)
Corresponding author
Butterfield, J.H.
ORCID
Butterfield, J.H.
Venue
The Journal of Allergy and Clinical Immunology: In Practice
Publisher
Elsevier BV
Published
2022-08
Volume
10
Issue
8
Pages
1974-1984
ISSN
2213-2198 (ISSN-L)
DOI
10.1016/j.jaip.2022.03.008
OpenAlex
W4220856174
Cited by
27
References
120
Citations by year
2026: 7 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 4
FWCI
1.91
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
  • PubMed (publishedVersion)
Funders
Mayo Foundation for Medical Education and Research
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
Keywords
mast cell activation syndrome, systemic mastocytosis, prostaglandin D2 metabolites, serum tryptase, hereditary alpha-tryptasemia, mast cell activation
MeSH terms
Histamine, Humans, Mast Cells, Mastocytosis, Prostaglandins, Biomarkers, Leukotriene E4, Tryptases

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