Mast Cell Activation Profiles in Perioperative Immediate Hypersensitivity Reactions: A GERAP Network Study

Area of Science:

• Anesthesiology
• Immunology
• Allergy

Background:

• Perioperative immediate hypersensitivity reactions (POHRs) are critical anesthetic complications.
• Mast cell activation (MCA) biomarkers like tryptase have diagnostic limitations.
• Understanding POHR phenotypes is crucial for effective management.

Purpose of the Study:

• To compare POHR patient phenotypes based on mast cell activation (MCA) profiles.
• To utilize tryptase and histamine assays for MCA profiling.
• To correlate clinical characteristics with MCA profiles in POHRs.

Main Methods:

• Retrospective multicenter study (2017-2024) of patients experiencing POHRs.
• MCA profiling based on tryptase levels (low vs. high) and histamine release.
• Analysis of clinical data and biomarker correlations across MCA profiles.

Main Results:

• 67% of 930 patients showed MCA; high tryptase-MCA (60%) and low tryptase-NoMCA (27%) were most common.
• POHRs were significantly more severe in the high tryptase-MCA group (85%) vs. low tryptase-NoMCA (43%).
• Some patients had histamine release only; MCA profiles varied by perioperative drugs, suggesting diverse mechanisms.

Conclusions:

• While high tryptase-MCA reactions often suggest IgE-mediated mechanisms, certainty is limited.
• Current diagnostic tools in clinical practice do not allow for high-confidence identification of POHR underlying mechanisms.
• Further research is needed to refine POHR diagnosis and management.