Basal Tryptase Levels Can Predict Clinical Severity in Hymenoptera Venom Anaphylaxis and Ischemic Cardiovascular Disorders

Farioli, L; Losappio, Laura; Schroeder, Jan Walter; Preziosi, Donatella; Scibilia, Joseph; Caron, L; Nichelatti, Michele; Pastorello, E. A.

doi:10.18176/jiaci.0363

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…Because of this correlation serum tryptase measurements have been proposed as a method for stratifying risk among Hymenoptera-allergic patients. Patients classified as low risk have tryptase values of <4 ng/mL (35.5% [n=50/141]), intermediate-risk ranging from ≥4 to 7.5 ng/mL (62.5% [n=107/172]), and high risk had tryptase values >7.5 ng/mL (88.5% [n=46/52]) (11). In these studies, it had been suggested that the patients with very high BST (>13.8 ng/ml), might be affected by a mast cell activation disorder.…”

Section: Hymenoptera Venom-induced Anaphylaxis (Hva) Severity Positively Correlates With Bst Levelsmentioning

confidence: 99%

“…Elevated basal serum tryptase (BST) levels have been associated with increased severity of anaphylaxis in a number of settings (1, 2) (3) (4) (5) (6)(7)(8). This association has been shown to be preeminent among individuals with Hymenoptera venom-induced anaphylaxis (HVA) (9)(10)(11)(12)(13)(14). Clonal mast cell diseases such as systemic mastocytosis (SM), have been demonstrated as causative of both BST elevation and HVA in many of these individuals -indeed this may be the presenting symptom of SM in otherwise healthy individuals (6).…”

Section: Introductionmentioning

confidence: 99%

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Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

O’Connell

Lyons

2020

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review.-To discuss the association between the common dominantly inherited genetic trait hereditary alpha-tryptasemia (HαT) and Hymenoptera venom-induced anaphylaxis (HVA).Recent findings.-Elevated BST has been correlated with more severe systemic anaphylaxis in humans in a number of settings -most notably in HVA. Clonal mast cell disease, in particular systemic mastocytosis, is frequently associated with elevated BST, and is a major risk factor for severe HVA. However, clonal mast cell diseases are believed to be rare, whereas HVA is relatively more common. HαT affects an estimated 3-5% of Western populations and is the common cause for elevated BST in these individuals. An association between HαT and severe HVA, as well as clonal mast cell disease has recently been demonstrated wherein this trait modifies reaction severity in venom allergic individuals. A mechanism underlying this association has been proposed through the identification of naturally occurring heterotetrameric tryptases and characterization of their unique physical attributes.Summary.-Here we discuss the long-standing association between elevated BST and HVA severity, how HαT fits into this landscape, and review the clinical and mechanistic evidence that supports HαT as a modifier of HVA.

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Section: Hymenoptera Venom-induced Anaphylaxis (Hva) Severity Positively Correlates With Bst Levelsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

O’Connell

Lyons

2020

Current Opinion in Allergy &Amp; Clinical Immunology

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“…In a recent study, we found that a tryptase value of approximately 7 ng/mL was associated with a more frequent occurrence of anaphylactic reactions in venom-allergic subjects. A similar value was also a predictor of major cardiac events in a population of patients with a history of acute coronary syndrome (ACS), showing that the mast cells in the cardiac muscle may be implied in the pathophysiology of necrosis and that tryptase can be an expression of cardiovascular diseases [9]. Other causes, however, could determine an increased basal tryptase value and could in their turn predispose to anaphylaxis.…”

Section: Introductionmentioning

confidence: 99%

Basal Tryptase High Levels Associated with a History of Arterial Hypertension and Hypercholesterolemia Represent Risk Factors for Severe Anaphylaxis in Hymenoptera Venom-Allergic Subjects over 50 Years Old

Pastorello

Borgonovo

Preziosi

et al. 2020

Int Arch Allergy Immunol

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Introduction: Allergy to Hymenoptera venom (HV) may lead to life-threatening anaphylaxis. Some of the factors influencing the symptom’s severity are still undetermined. The aim of this study was to identify the clinical aspects associated with the most severe reactions in a population with HV allergy, by comparing clinical and immunochemical biomarkers between patients with previous local large reactions (LLRs) and systemic reactions (SRs). Methods: We selected adult patients with a history of HV allergy, with positive diagnostic tests and a correlation with one single Hymenoptera species. Age, gender, atopy, serum basal tryptase (sBT) value, total IgE, venom-specific IgE, history of hypertension, cardiovascular diseases, and hypercholesterolemia were compared between patients with previous LLRs and SRs. Results: 460 adult patients (381 SRs, 79 LLRs) were included. Age (p = 0.0097), male gender (p < 0.0001), arterial hypertension (p = 0.046), hypercholesterolemia (p = 0.009), and higher sBT levels (p = 0.0004) were significantly associated with severe reactions as independent variables. Moreover, considering the previous variables as risk factors, there was a significant and progressive increase in the odds of being Mueller III + IV as the number of positive variables increased. Patients with sBT ≥6.4 ng/mL adjusted for any of the positive variables had increased the risk of Mueller grade IV reaction (p < 0.0001). Conclusion: According to our results, older age, male gender, arterial hypertension, hypercholesterolemia, and increased levels of sBT ≥6.4 ng/mL are risk factors for severe anaphylaxis to HV in adults. Atopy and allergic asthma do not increase the risk of HV-induced SRs.

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“…For example, many authors have identi ied the presence of hypertension or various types of cardiovascular diseases as the main risk factors for severe anaphylactic reactions [18]. Moreover, in adults the presence of Mastocytosis or in any case of an elevated level of tryptase in basal condition has been identi ied as factors favoring severe SRs [19]. In children in our population, tryptase levels were found to be superimposable between the 2 considered groups of LLRs with respect to both moderate and severe SRs.…”

Section: Discussionmentioning

confidence: 99%

Higher venom-specific IgE levels differentiate children with previous local large reactions from children with previous systemic reactions of different severity

Anna¹,

Borgonovo²,

Piantanida³

et al. 2021

Arch Asthma Allergy Immunol

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Introduction: Risk factors for systemic reactions (SRs) from hymenoptera venom (HV) allergy are well known in the adult population but they have been little studied in the pediatric one. Method: The aim of our study was to identify risk factors for SRs in a population of children allergic to HV, comparing a series of clinical (age, gender, atopy, asthma) and laboratory (total IgE, tryptase, venom-specific IgE levels) variables between patients with at least two large local reactions (LLRs) and patients with SRs of different severity for the identified insect. We selected a population of HV allergic children aged <15 years with LLRs or SRs stratified according to Mueller grades after stinging. Results: The population included 80 children, 35 with at least 2 LLRs and 45 with SRs. The level of specific IgE for vespid (Polistes dominula, Vespula species) venoms was significantly higher (p = 0.0321) in children with SRs (Mueller grade II+III+IV) than in those with LLRs and the same significance was also found for specific IgE for Apis mellifera, considering SRs group (Mueller grade I+II+III+IV) in respect with LLRs group (p = 0.0001). Conclusion: The main difference in our pediatric population was the highest level of specific IgE in children with a history of SRs compared to those with a history of LLRs for both vespids and honey bees. These results, once confirmed on a larger population, could suggest the opportunity to follow the behavior of venom specific IgE in children with LLRs to reveal a risk to develop future more serious reactions.

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Basal Tryptase Levels Can Predict Clinical Severity in Hymenoptera Venom Anaphylaxis and Ischemic Cardiovascular Disorders

Abstract: Inmunoterapia con alérgenos. Ácaros del polvo doméstico. Diagnóstico por componentes. Eficacia clínica. Alérgenos mayores.

Cited by 10 publications

References 8 publications

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia

Basal Tryptase High Levels Associated with a History of Arterial Hypertension and Hypercholesterolemia Represent Risk Factors for Severe Anaphylaxis in Hymenoptera Venom-Allergic Subjects over 50 Years Old

Higher venom-specific IgE levels differentiate children with previous local large reactions from children with previous systemic reactions of different severity

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