☆ 4.1 Article

Clinical characteristics and risk profile of patients with elevated baseline serum tryptase

ALLERGOLOGIA ET IMMUNOPATHOLOGIA (2014)

Journal

ALLERGOLOGIA ET IMMUNOPATHOLOGIA

Volume 42, Issue 6, Pages 544-552

Publisher

ELSEVIER DOYMA SL

DOI: 10.1016/j.aller.2014.05.002

Keywords

Basal serum tryptase; Mast cell activation syndrome; Mastocytosis; Anaphylaxis

Funding

Floridsdorf Allergy Centre

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Abstract

Background: The clinical relevance of elevated basal serum tryptase (eBST >= 11.4 ng/ml) often remains unclear. Methods: BST was assessed in 15,298 patients attending our outpatient clinic. Frequency and severity of anaphylaxis was compared in 900 patients with eBST and 900 patients with normal BST. The prevalence of eBST was evaluated in patients with drug reactions, urticaria, gastrointestinal symptoms or venom allergy. Mast cell-associated symptoms were recorded prospectively in 100 patients with eBST and 100 controls using a standardised questionnaire. Results: 5.9% (n=900) of 15,298 patients had eBST >= 11.4 ng/ml (mean 20 +/- 21 ng/ml, 11.4-390 ng/ml). In 47% of them BST was <15.0 and in 78% <20.0 ng/ml. In patients with normal BST (4.5 +/- 2.1 ng/ml), mean levels increased continuously with age (0.28 ng/ml per decade; p < 0.001). Fatigue, meteorism, muscle/bone ache, vertigo, tachycardia, flush, palpitations, diarrhoea and oedema were associated with eBST (p< 0.05 to <0.0001) without significant differences between slightly (11.4-20 ng/ml) or strongly (>20 ng/ml) eBST. eBST was significantly associated with adverse reactions to drugs (34%), radio contrast media (15%) and insect stings (24%) (p< 0.05). Anaphylaxis was more common in patients with eBST (21% vs. 14%, p< 0.001). The relative role of insect stings, drugs and food as the most important triggers was similar in patients with elevated and normal BST. Severe reactions (grade 3/4) occurred most often in subjects with BST >20 ng/ml (BST <11.4 mg/ml: 2.8%; 11.5-20 ng/ml: 5.9%; >20 ng/ml: 12.4%). Conclusions: In clinical practice it appears reasonable to assess BST, besides after anaphylactic reactions also in patients suffering repeatedly from vertigo, flush, tachycardia, palpitations, oedema and nausea. Even patients with slightly eBST have a higher risk of anaphylaxis and experience more severe reactions. (C) 2013 SEICAR Published by Elsevier Espana, S.L.U. All rights reserved.

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Prevalence of mastocytosis and Hymenoptera venom allergy in the United States

Charles F. Schuler, Sofija Volertas, Dilawar Khokhar, Huseyin Yuce, Lu Chen, Onur Baser, Jenny M. Montejo, Cem Akin

Summary: Using an insurance claims database and a retrospective study at the University of Michigan, it was found that the prevalence of HVA in the US is lower than previously reported, while the prevalence of mastocytosis in patients with HVA is higher but still lower than previously reported. There was no correlation between tryptase level and reaction severity in patients undergoing VIT.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2021)