Clinical utility of serum tryptase levels in pediatric anaphylaxis

Abstract

Introduction: This study aimed to evaluate the preliminary diagnosis, demographic characteristics, and outcomes of patients whose serum total tryptase levels were measured while in a tertiary pediatric hospital and to ascertain the role of serum tryptase levels in the etiology, diagnosis, severity, and course of systemic anaphylaxis.Methods: Patients ages between 1 month and 17 years who were followed up in the pediatric emergency department or as inpatients and with a diagnosis of immediate-type reactions between September 1, 2019, and August 31, 2021, were includedin the study. Patient data were obtained retrospectively by examination of medical records and patient observation forms.Results: It was determined that serum tryptase levels were measured in a total of 310 patients during the study period.One hundred and fifty-five patients who met the defined diagnostic criteria were named as the anaphylaxis group and their data were detailed. The serum tryptase elevation was detected in 15.5% of the patients among the samples that met the anaphylaxis diagnostic criteria. No relationship was found between the serum total tryptase levels, the triggering factor, and the severity of anaphylaxis.Discussion: Anaphylaxis is a complex syndrome that involves different phenotypes that develop with various triggers in which different immunologic pathways, cell types, and mediators play a role. Serial measurements, including the basal value measured at least 24 hours after the symptoms disappear, are useful to confirm the diagnosis and guide the diagnostic tests during the follow-up, especially allergy evaluation.

Anafilaksiye Güncel Yaklaşım

“…Even if the serum basal tryptase level measured during anaphylaxis results within normal limits, it is recommended to measure the serum basal tryptase level again 24 hours after the symptoms of anaphylaxis have completely resolved (37). A peak mast cell tryptase (MCT) >1.2 x basal tryptase + 2 ng/L has been proposed to diagnose acute mast cell activation (38).…”