Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: An observational study
Abstract
BACKGROUND: Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination. METHODS: A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured. RESULTS: Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than ([1.2×baseline tryptase] + 2] μg/L to be considered a clinically significant rise. In our cohort, this algorithm achieved 94% positive predictive value (PPV), 53% negative predictive value (NPV), 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis. CONCLUSION: Total tryptase levels in serum discriminated between nonanaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The "20% + 2 formula" was subsequently validated by several studies.
“This so-called “20% + 2 formula” was subsequently validated by several studies (31–33).”
From Defining “Normal” basal serum tryptase levels: a context-dependent approach to improve diagnostics in systemic mastocytosis (2025) · cites this paper as [32]
Cites
Valent, P., Akin, C., Arock, M., Brockow, K., Butterfield, J. H., Carter, M. C., Castells, M., Escribano, L., Hartmann, K., Lieberman, P., et al. (2012) · International Archives of Allergy and Immunology · doi:10.1159/000328760 · Cited by 654 · see citing works
Self-citationSchwartz, L. B., Yunginger, J. W., Miller, J., Bokhari, R., & Dull, D. (1989) · Journal of Clinical Investigation · doi:10.1172/jci114051 · Cited by 456 · cited 3× · see citing works
“Mature tryptase was measured in the VCU Laboratory using the biotin‐conjugated G5 monoclonal anti‐tryptase IgG for detection and the B12 monoclonal anti‐tryptase IgG for capture.(9,12,25) Consecutive acute samples from 42 patients were retrospectively selected from the study population.”
BackgroundMethodSelf-citationLyons, J. J., Yu, X., Hughes, J. D., Le, Q. T., Jamil, A., Bai, Y., Ho, N., Zhao, M., Liu, Y., O'Connell, M. P., et al. (2016) · Nature Genetics · doi:10.1038/ng.3696 · Cited by 394 · see citing works
Self-citationSchwartz, L. B., Sakai, K., Bradford, T. R., Ren, S., Zweiman, B., Worobec, A. S., & Metcalfe, D. D. (1995) · Journal of Clinical Investigation · doi:10.1172/jci118337 · Cited by 371 · see citing works
Self-citationLyons, J. J., Sun, G., Stone, K. D., Nelson, C., Wisch, L., O'Brien, M., Jones, N., Lindsley, A., Komarow, H. D., Bai, Y., et al. (2014) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.11.039 · Cited by 136 · see citing works
Self-citationSchwartz, L. B., Min, H.-K., Ren, S., Xia, H.-Z., Hu, J., Zhao, W., Moxley, G., & Fukuoka, Y. (2003) · The Journal of Immunology · doi:10.4049/jimmunol.170.11.5667 · Cited by 120 · see citing works
Self-citationBaretto, R. L., Beck, S., Heslegrave, J., Melchior, C., Mohamed, O., Ekbote, A., Huissoon, A. P., & Krishna, M. T. (2017) · Allergy · doi:10.1111/all.13226 · Cited by 111 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Weiler, C. R., Austen, K. F., Akin, C., Barkoff, M. S., Bernstein, J. A., Bonadonna, P., Butterfield, J. H., Carter, M., Fox, C. C., Maitland, A., et al. (2019) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2019.08.023 · Cited by 123 · see citing works
Defining baseline variability of serum tryptase levels improves accuracy in identifying anaphylaxis
Mateja, A., Wang, Q., Chovanec, J., Kim, J., Wilson, K. J., Schwartz, L. B., Glover, S. C., Carter, M. C., Metcalfe, D. D., Brittain, E., et al. (2022) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2021.08.007 · Cited by 91 · see citing works
Self-citationVitte, J., Sabato, V., Tacquard, C., Garvey, L. H., Michel, M., Mertes, P.-M., Ebo, D. G., Schwartz, L. B., & Castells, M. C. (2021) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2021.03.011 · Cited by 79 · see citing works
Self-citationEbo, 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., et al. (2021) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2021.03.050 · Cited by 26 · see citing works
Anaphylaxis: Mediators, Biomarkers, and Microenvironments
Fernandez-Bravo, S., Palacio-Garcia, L., Requena-Robledo, N., Yuste-Montalvo, A., Nuñez-Borque, E., & Esteban, V (2022) · Journal of Investigational Allergology and Clinical Immunology · doi:10.18176/jiaci.0854 · Cited by 17 · see citing works
Defining hereditary alpha-tryptasemia as a risk/modifying factor for anaphylaxis: Are we there yet?
Couto, M. L., Silva, M., Barbosa, M. J., Ferreira, F., Fragoso, A. S., & Azenha Rama, T. (2023) · European Annals of Allergy and Clinical Immunology · doi:10.23822/eurannaci.1764-1489.288 · Cited by 10 · see citing works
Crupi, F., Caroprese, J., & Mannelli, F. (2025) · Frontiers in Allergy · doi:10.3389/falgy.2025.1592001 · Cited by 2 · see citing works
- Authors
- Vitte, J., Amadei, L., Gouitaa, M., Mezouar, S., Zieleskiewicz, L., Albanese, J., Bruder, N., Lagier, D., Mertès, P. M., Mège, J., Schwartz, L. B., & Leone, M.
- Affiliations
- Aix-Marseille Université (FR)
- Aix‐Marseille Univ, APHM, Hôpital de la Conception Service d'Anesthésie et de Réanimation Marseille France
- Hôpitaux Universitaires de Strasbourg (FR)
- Virginia Commonwealth University (US)
- Aix‐Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection Marseille France
- Corresponding author
- Vitte, Joana
- ORCID
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2019-03-21
- Volume
- 74
- Issue
- 6
- Pages
- 1157-1165
- ISSN
- 0105-4538 (ISSN-L)
- 1398-9995
- OpenAlex
- W2915193652
- Cited by
- 94
- References
- 7
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 14 · 2023: 12 · 2022: 12 · 2021: 15 · 2020: 13 · 2019: 4
- FWCI
- 8.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Allergy (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Keywords
- perioperative anaphylaxis, serum tryptase, anaphylaxis diagnosis, diagnostic algorithm, hypersensitivity, diagnostic accuracy
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Anaphylaxis, Female, Hospitals, University, Humans, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Serologic Tests, Biomarkers, Consensus, Tryptases, Young Adult, Perioperative Period
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
