A 17-year experience in perioperative anaphylaxis 1998-2015: Harmonizing optimal detection of mast cell mediator release
Abstract
BACKGROUND: Sheffield NARCOS (National Adverse Reactions Advisory Service) investigates suspected perioperative anaesthetic reactions using serial tryptase, urinary methylhistamine (UMH) and clinical information. Further recommendations for additional allergy clinic assessment are provided. OBJECTIVE: To establish a robustly measurable protocol for identifying mast cell mediator (MMR) release in this cohort. To compare these thresholds with previously suggested thresholds and algorithms. METHOD: A review of 3455 NARCOS cases referred with a suspected perioperative allergic reaction. Tryptase, UMH and clinical details were analysed. A total of 1746 cases were graded using the Ring and Messmer scale. Reaction grade, tryptase and UMH changes were compared with statistical and graphical presentations appropriate to non-normally distributed measurements using Analyse-IT software. RESULTS: Sensitive strategies such as 3 μg/L or 20% are measurable and translatable and would substantially increase detection of potentially relevant changes in tryptases. Adequate quality assurance for low-level measurement is needed. An incremental threshold of 20% would identify potential MMR in an additional 14% of cases with peak tryptase (Tp) between 5 and 14 μg/L and a further 15% with Tp below 5 μg/L. Further work is required to establish the diagnostic performance characteristics of this more sensitive approach. UMH also identified up to 120 further cases of potential MMR in the absence of tryptase increments. CONCLUSIONS AND CLINICAL RELEVANCE: Future studies should establish and compare the predictive performance characteristics of each strategy against clinical phenotypes. A single agreed definition of positive serial tryptases is needed to enable robust evaluation of diagnostic strategies. This could serve as a harmonized standard for comparative studies of case series from different centres.
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Different approaches have been proposed such as a delta tryptase > 3 ng/mL or a rise of 35% in tryptase.
“Different approaches have been proposed such as a delta tryptase > 3 ng/mL or a rise of 35% in tryptase [27,28].”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [28]
The section “How should Tryptase be used in establishing MMR?” (page not provided) discusses a 3 µg/L strategy, equivalent to a 3 ng/mL change. The Results (page not provided) also discuss a 20% rise, but the passages do not support the claimed 35% threshold. (LLM, conf=0.88)
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- Authors
- Egner, W., Sargur, R., Shrimpton, A., York, M., & Green, K.
- Affiliations
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Egner, W.
- ORCID
- Venue
- Clinical & Experimental Allergy
- Publisher
- Wiley
- Published
- 2016-09-21
- Volume
- 46
- Issue
- 11
- Pages
- 1465-1473
- ISSN
- 0954-7894 (ISSN-L)
- 1365-2222
- OpenAlex
- W2505043423
- Cited by
- 31
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 4
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical & Experimental Allergy (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- 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
- perioperative anaphylaxis, mast cell mediator release, tryptase, diagnostic thresholds, narco
- MeSH terms
- Anaphylaxis, Female, Humans, Male, Mast Cells, Methylhistamines, Severity of Illness Index, Time Factors, Biomarkers, Cytokines, Inflammation Mediators, History, 20th Century, History, 21st Century, Tryptases, Perioperative Period
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