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Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients
Abstract
BACKGROUND: The diagnosis of anaphylaxis is based on clinical history since no reliable biological marker is currently available to confirm the diagnosis. OBJECTIVE: It was the aim of this study to determine sequential serum tryptase concentrations during anaphylaxis and to evaluate its potential as a diagnostic marker. METHODS: We performed a prospective study including patients with acute anaphylaxis (according to the National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria) attending the emergency department. Demographic characteristics, anaphylactic triggers, specific risk factors, clinical characteristics and management of anaphylaxis were recorded. Serum tryptase was measured at 1-2 h (T1), 4-6 h (T2) and 12-24 h (T3) following onset of the episode and at basal conditions (TB). RESULTS: A total of 102 patients were included (63 females, mean age 47.4 ± 19.1 years). Tryptase concentration at T1 (19.3 ± 15.4 µg/l) was significantly higher than at T2, T3 and TB (all <11.4 µg/l; p < 0.0001). Importantly, tryptase was not raised in 36.3% of cases; furthermore, in 60.6% of these patients, no changes were observed in tryptase levels comparing T1 and TB (ΔT1-TB = 0). Tryptase was more frequently elevated in more severe anaphylaxis (p < 0.0001) and positively correlated with the grades of severity (p < 0.001, r = 0.49). Anaphylaxis was more severe and tryptase concentration higher when the causative agent was a drug compared to food, both at T1 (p = 0.045) and at TB (p = 0.019). Age and coronary risk factors were associated with more severe anaphylaxis (p = 0.001). CONCLUSION: Tryptase is a biomarker related to the severity of anaphylaxis. However, since its concentration remains unaltered in a considerable number of patients during acute anaphylaxis, there is a need for more reliable diagnostic biological tests.
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“Generally, the severity and magnitude of hypotension in anaphylaxis correlate with the height of tryptase [29,30].”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [29]
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Metadata
- Authors
- Sala-Cunill, A., Cardona, V., Labrador-Horrillo, M., Luengo, O., Esteso, O., Garriga, T., Vicario, M., & Guilarte, M.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Venue
- International Archives of Allergy and Immunology
- Publisher
- S. Karger AG
- Published
- 2012-09-25
- Volume
- 160
- Issue
- 2
- Pages
- 192-199
- ISSN
- 1018-2438 (ISSN-L)
- 1423-0097
- OpenAlex
- W2001266300
- Cited by
- 179
- References
- 32
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 11 · 2023: 15 · 2022: 20 · 2021: 14 · 2020: 14 · 2019: 11 · 2018: 13 · 2017: 14 · 2016: 10 · 2015: 16 · 2014: 16 · 2013: 8 · 2012: 1
- FWCI
- 9.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Archives of Allergy and Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
- Keywords
- anaphylaxis, serum tryptase, diagnostic biomarkers, anaphylaxis severity, drug-induced anaphylaxis, food-induced anaphylaxis, emergency department
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anaphylaxis, Female, Humans, Male, Middle Aged, Biomarkers, Tryptases, Young Adult
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