Risk assessment in anaphylaxis: current and future approaches

Area of Science:

• Allergy and Immunology
• Clinical Diagnostics
• Risk Assessment

Background:

• Current anaphylaxis diagnosis lacks optimal laboratory confirmation.
• Distinguishing allergen-sensitized individuals at risk from tolerant ones is difficult.

Purpose of the Study:

• Review anaphylaxis pathophysiology and effector mechanisms.
• Explore development of diagnostic tests and improved risk stratification methods.
• Establish a research agenda for anaphylaxis risk assessment.

Main Methods:

• Reviewed effector mechanisms in anaphylaxis pathophysiology.
• Investigated novel diagnostic markers like serum tryptase and beta-tryptase.
• Explored methods to differentiate sensitization from clinical reactivity, including IgE, epitope mapping, and basophil activation.

Main Results:

• New diagnostic approaches include serial and baseline total tryptase measurements.
• Mature beta-tryptase offers greater specificity; other mast cell products may be useful.
• Distinguishing at-risk individuals involves IgE ratios, epitope-specific IgE, basophil activation, and cytokine responses.

Conclusions:

• Developed algorithms for anaphylaxis risk assessment.
• A research agenda is proposed to enhance diagnostic accuracy and identify individuals at high risk.
• Improved diagnostic tools are crucial for managing anaphylaxis risk.