An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell‐mediated hypersensitivity reaction: a prospective study in H ymenoptera venom allergic patients
Open accessAbstract
BACKGROUND: During a systemic hypersensitivity reaction (SR), an increase in serum tryptase compared to the baseline value is an indicator of mast cell activation, most often due to an IgE-mediated mechanism. OBJECTIVE: To study the relevance of an increase in serum tryptase below the upper normal value of 11.4 ng/mL. METHODS: Serum tryptase levels were measured in 35 patients with Hymenoptera venom hypersensitivity before and during venom exposure. Of these, 20 developed SR to stings or following venom injections during immunotherapy (reactors), while 15 tolerated reexposure to stings or venom injections during immunotherapy without SR (non-reactors). Serum tryptase was estimated at 2, 5 and 24 h after exposure and was compared to a baseline value obtained before or at least 72 h after exposure. RESULTS: Considering circadian variation of serum tryptase, a relative increase to ≥135% of the baseline value (relative delta bound) was defined to indicate mast cell activation. Such an increase was observed in 17 of 20 reactors (85%), but none of 15 non-reactors. A serum tryptase of ≥11.4 ng/mL following venom exposure was observed in eight of the 20 reactors (40%) and 2 (13.3%) of the 15 non-reactors. Both these non-reactors also had an elevated baseline serum tryptase. CONCLUSIONS AND CLINICAL RELEVANCE: Serum tryptase values obtained during a suspected hypersensitivity reaction must always be compared to a baseline value. A relative tryptase increase to ≥135% of the baseline value during a suspected hypersensitivity reaction indicates mast cell activation even below 11.4 ng/mL.
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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 [27]
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- Authors
- Borer‐Reinhold, M., Haeberli, G., Bitzenhofer, M., Jandus, P., Hausmann, O., Fricker, M., Helbling, A., & Müller, U.
- Affiliations
- Allergiestation Medizinische Klinik Spital Netz Bern Ziegler Bern Switzerland
- University of Bern (CH)
- Corresponding author
- Müller, U.
- Venue
- Clinical & Experimental Allergy
- Publisher
- Wiley
- Published
- 2011-09
- Volume
- 41
- Issue
- 12
- Pages
- 1777-1783
- ISSN
- 0954-7894 (ISSN-L)
- 1365-2222
- OpenAlex
- W2010424859
- Cited by
- 73
- References
- 24
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 4 · 2017: 7 · 2016: 10 · 2015: 4 · 2014: 8 · 2013: 6 · 2012: 3
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- Locations
- Clinical & Experimental Allergy (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Venomous Animal Envenomation and Studies
- Keywords
- serum tryptase, mast cell activation, systemic hypersensitivity reaction, hymenoptera venom allergy, venom immunotherapy, circadian variation, IgE-mediated hypersensitivity
- MeSH terms
- Adolescent, Adult, Aged, Anaphylaxis, Animals, Arthropod Venoms, Female, Humans, Hymenoptera, Hypersensitivity, Immediate, Immunoglobulin E, Insect Bites and Stings, Male, Mast Cells, Middle Aged, Reference Values, Tryptases, Young Adult
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