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Elevated serum tryptase levels in a patient with protracted anaphylaxis
R Z Vinuya1, M R Simon, L B Schwartz
1Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
Annals of Allergy
|September 1, 1994
Summary
Protracted anaphylaxis can involve ongoing mast cell activation, indicated by elevated serum tryptase levels days after symptom onset. This finding highlights mast cell degranulation
Area of Science:
- Immunology
- Allergy and Clinical Immunology
Background:
- Anaphylaxis typically occurs rapidly after antigen exposure but can present as prolonged or biphasic reactions.
- The incidence and pathophysiology of protracted anaphylaxis remain incompletely understood.
- Mast cell activation, a key feature of anaphylaxis, can be indicated by serum tryptase levels.
Observation:
- A case report details a 33-year-old male experiencing prolonged anaphylactic symptoms including gastrointestinal distress, urticaria, and hemodynamic changes.
- Serum tryptase concentrations were measured using radioimmunoassay.
- Elevated serum tryptase levels were observed on the fourth and fifth days of symptoms.
Findings:
- Serum tryptase levels remained elevated at 7.2 ng/mL and 5.1 ng/mL on hospital days 1 and 2 (symptom days 4 and 5).
- Tryptase levels normalized to < 1.0 ng/mL five months post-symptom resolution.
- These findings suggest continued mast cell degranulation during protracted anaphylaxis.
Implications:
- Continued mast cell degranulation may play a significant role in the pathophysiology of protracted anaphylaxis.
- Measuring serum tryptase can help identify mast cell involvement in prolonged anaphylactic episodes.
- This study supports the hypothesis that mast cell activation is crucial in protracted anaphylaxis.