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Can serum mast cell tryptase help diagnose anaphylaxis?
Simon G A Brown1, Konrad E Blackman, Robert J Heddle
1Department of Emergency Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia. simon.brown@health.wa.gov.au
Emergency Medicine Australasia : EMA
|July 9, 2004
Summary
Serum tryptase is a useful but imperfect marker for diagnosing anaphylaxis. Serial measurements and histamine levels significantly improve diagnostic accuracy for this severe allergic reaction.
Area of Science:
- Allergy and Immunology
- Clinical Diagnostics
Background:
- Anaphylaxis is a severe, life-threatening allergic reaction.
- Accurate and timely diagnosis is crucial for effective management.
Purpose of the Study:
- To evaluate the diagnostic utility of serum mast cell tryptase levels for diagnosing anaphylaxis.
- To assess the impact of serial tryptase measurements and histamine levels on diagnostic performance.
Main Methods:
- Conducted a venom immunotherapy trial involving 64 sting challenges.
- Collected serum samples at baseline, 15 minutes, and 60 minutes post-sting.
- Measured serum tryptase and plasma histamine levels, comparing them to a clinical diagnosis of anaphylaxis.
Main Results:
- Single tryptase measurements showed limited sensitivity (0.36) but high specificity (0.93) at the recommended cutoff.
- Adjusting the cutoff to 9.0 microg/L improved sensitivity to 0.55 while maintaining specificity.
- Serial tryptase measurements (increase ≥ 2.0 microg/L) demonstrated significantly higher sensitivity (0.73) and specificity (0.98).
- Combining tryptase and histamine measurements further increased sensitivity to 0.90.
Conclusions:
- Serum tryptase alone should be interpreted with caution for diagnosing anaphylaxis.
- Serial tryptase measurements offer improved diagnostic accuracy.
- Further research on serial tryptase and histamine in emergency settings is recommended.