Background Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work‐up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. Methods All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work‐up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA > 11 (F1), or >2 + 1.2 × TB (F2), or >3 + TB (F3), or >120%TB (F4), were applied. Results One hundred and sixty‐two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut‐off value of TA to distinguish positive from negative allergy testing patients was 9.8 μg/L with an AUC of 0.817 (95% CI: 0.752–0.882, p < .001). The 93% PPV threshold for TA was 33 μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). Conclusion The optimal cut‐off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8 μg/L. TA value of 33 μg/L was required to achieve >90% PPV.
Reference intervals (RIs) for prolactin are of high clinical importance for diagnosis, treatment, and prognosis of hypothalamic-pituitary disorders. The aim of this study was to verify the Roche reference ranges for serum prolactin in children, adolescents, adults, and the elderly. : An indirect method based on currently laboratory data was used on the reference ranges. Nine thousand one hundred and thirteen prolactin results were included. Pregnancy, lactation, exercise and reported pathologies were ruled out and only samples were collected between 8AM and 12PM were used. Reference ranges with a confidence interval of 95% (95% CI) were estimated. : Compared to the manufacturer's reference values and for the corresponding age group, the median values obtained in our study were 10 – 60% higher depending on the age and sex of the patients. Elevated levels of serum prolactin were observed in the neonatal period and values decrease until median values near 200 mUI/L in childhood. During the children's period, no gender differences were observed for prolactin level. The gender difference in prolactin levels became significant from pre-adolescence until the age of 60. Prolactin levels increased significantly (p<0.001) between children and young adults, followed by a gradual and continuous decrease until young senior age.: The prolactin reference values proposed by the manufacturer in the data sheet appeared unsuitable. Laboratories should review reference ranges, and a partitioning with sex and different age groups may be appropriate.
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