Mast Cell Activation During Suspected Perioperative Hypersensitivity: A Need for Paired Samples Analysis

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Pharmacology

Background:

• Perioperative hypersensitivity (POH) reactions present diagnostic challenges.
• Mast cell activation (MCA) during POH is indicated by increased serum tryptase.
• Identifying reliable markers for MCA is crucial for patient management.

Purpose of the Study:

• To evaluate the diagnostic accuracy of various serum tryptase thresholds for documenting MCA in suspected POH.
• To compare single and paired tryptase measurements in diagnosing POH.
• To assess the correlation between baseline tryptase levels and POH severity.

Main Methods:

• Serum tryptase levels (acute and baseline) were measured in patients with POH and healthy controls.
• Different cutoff values for tryptase increase and percentage increase were analyzed.
• The consensus formula (aST > [1.2 × bST + 2]), absolute aST values, and percentage increase were compared.

Main Results:

• Patients with POH exhibited significantly higher baseline serum tryptase (bST) and acute serum tryptase (aST) than controls.
• The consensus formula and a tryptase increase ≥ 3.2 ng/mL demonstrated the highest accuracy (81% and 82%) in documenting MCA.
• A bST > 8 ng/mL was associated with increased POH severity and anaphylaxis occurrence.

Conclusions:

• The consensus formula is recommended for detecting MCA in perioperative hypersensitivity reactions.
• Elevated baseline serum tryptase (> 8 ng/mL) is a potential indicator of anaphylaxis in POH.
• Accurate MCA detection aids in understanding and managing POH.