Disease spectrum in patients with elevated serum tryptase levels

Area of Science:

• Clinical immunology
• Hematology
• Allergy and immunology

Background:

• Elevated serum tryptase can indicate mastocytosis, a rare disease with systemic and skin manifestations.
• Mastocytosis diagnosis requires careful evaluation of tryptase levels and associated symptoms.

Purpose of the Study:

• To investigate the underlying diseases in patients with elevated serum tryptase levels.
• To determine if increased tryptase is a reliable diagnostic marker for mastocytosis.

Main Methods:

• Retrospective analysis of 96 patients with serum tryptase >15 μg/L.
• Control investigations for baseline tryptase in 48 patients.

Main Results:

• Only 16% of patients with elevated tryptase had mastocytosis; the majority had anaphylaxis, urticaria, angioedema, or other conditions.
• 85% of patients with follow-up showed continuously elevated tryptase levels (>15 μg/L), with 62% exceeding 20 μg/L.
• Elevated tryptase levels (>20 μg/L) were frequently observed in non-mastocytosis patients, including those with anaphylaxis and urticaria.

Conclusions:

• Elevated tryptase levels (>20 μg/L) are common in non-mastocytosis conditions like urticaria, angioedema, and anaphylaxis.
• Baseline tryptase >20 μg/L is a minor criterion for mastocytosis, necessitating further diagnostic work-up.
• Patients with elevated tryptase should be screened for mastocytosis, including skin examination and bone marrow biopsy if indicated.