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Tryptase levels are not increased during vancomycin-induced anaphylactoid reactions
C L Renz1, D Laroche, J D Thurn
1Department of Anesthesia and Critical Care, The University of Chicago, Illinois, USA.
Anesthesiology
|September 22, 1998
Summary
Plasma tryptase levels do not significantly increase during drug-induced anaphylactoid reactions. This finding helps differentiate these reactions from immunoglobulin E-mediated anaphylaxis, clarifying diagnosis and treatment.
Area of Science:
- Pharmacology
- Immunology
- Clinical Medicine
Background:
- Anaphylaxis (immunoglobulin E-mediated) and anaphylactoid reactions (chemically mediated) present similar symptoms but have different mechanisms.
- Distinguishing between these reaction types is crucial for accurate diagnosis, treatment, and medicolegal clarity.
- Tryptase levels are established markers for anaphylactic reactions but their role in anaphylactoid reactions was previously unevaluated.
Purpose of the Study:
- To investigate plasma tryptase levels during drug-induced anaphylactoid reactions.
- To determine if tryptase can differentiate anaphylactoid reactions from anaphylaxis.
- To evaluate the efficacy of antihistamine chemoprophylaxis in preventing vancomycin-induced reactions.
Main Methods:
- A prospective, randomized, double-blinded, placebo-controlled trial involving 40 patients undergoing elective arthroplasty.
- Patients received rapid vancomycin infusion with either antihistamine pretreatment (diphenhydramine and cimetidine) or placebo.
- Plasma tryptase and histamine levels were measured, alongside clinical symptoms, to assess reaction severity and differentiate mechanisms.
Main Results:
- Plasma tryptase levels remained unchanged despite elevated histamine levels and clinical symptoms indicative of anaphylactoid reactions.
- Histamine levels greater than 1 ng/ml correlated significantly with hypotension, rash, and infusion cessation.
- Antihistamine pretreatment effectively reduced the incidence and severity of vancomycin-induced hypersensitivity reactions.
Conclusions:
- Plasma tryptase levels are not significantly elevated in drug-induced anaphylactoid reactions.
- Tryptase measurement can be a valuable tool to distinguish between chemically mediated anaphylactoid reactions and immunoglobulin E-mediated anaphylaxis.
- Antihistamines are effective in preventing and mitigating symptoms of vancomycin-induced anaphylactoid reactions.
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