Insect-sting challenge in 138 patients: Relation between clinical severity of anaphylaxis and mast cell activation†

Linden, P.-W. G. Van Der; Hack, C. E.; Poortman, J.; Vivie-Kipp, Y. C.; Struyvenberg, A; Zwan, J. K. Van Der

doi:10.1016/s0091-6749(06)80017-5

Cited by 153 publications

(93 citation statements)

References 30 publications

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“…Also, G5 levels were undetectable when B 12 levels were > 20 ng/ml in eight of those with type I mastocytosis, one with type II and two with type III. Median levels of tryptase measured with the B 12 immunoassay were significantly higher in type 1 (28 ng/ml), type 11 (141 ng/ml), and type III (170 ng/ml) mastocytosis than in the control groups with unrelated diseases (3.8 ng/ml), urticaria (3.2 ng/ml), and healthy (4.5 ng/ml) subjects (P < 0.002). Although there was a tendency for mastocytosis subjects in category I to have lower tryptase levels than those of categories II and III, comparisons of the median values did not show a statistically significant difference (P > 0.2).…”

Section: Resultsmentioning

confidence: 86%

“…The G5 immunoassay used the G5 mAb for capture and the noncompeting G4 mAb for detection. With each immunoassay comparable levels of tryptase can be measured in serum or plasma during insect sting-induced systemic anaphylaxis, where levels correlate to the severity of the clinical reaction (9)(10)(11). Tryptase in serum and plasma obtained from healthy control subjects is not detectable by the G5 immunoassay (< 1 ng/ml), whereas the B 12 immunoassay reveals that serum and plasma samples from normal subjects contain -5 ng/ml of tryptase.…”

Section: Introductionmentioning

confidence: 99%

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The alpha form of human tryptase is the predominant type present in blood at baseline in normal subjects and is elevated in those with systemic mastocytosis.

Schwartz¹,

Sakai²,

Bradford³

et al. 1995

J. Clin. Invest.

342

251

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Tryptase, a protease produced by all mast cells, was evaluated as a clinical marker of systemic mastocytosis. Two sandwich immunoassays were evaluated, one which used the mAb G5 for capture, the other which used B12 for capture. The B12 capture assay measured both recombinant a-and .-tryptase, whereas the G5 capture assay measured primarily recombinant f8-tryptase. G5 binds with low affinity to both recombinant c-tryptase and tryptase in blood from normal and nonacute mastocytosis subjects, and binds with high affinity to recombinant ,B-tryptase, tryptase in serum during anaphylaxis, and tryptase stored in mast cell secretory granules. B12 recognizes all of these forms of tryptase with high affinity. As reported previously, during systemic anaphylaxis in patients without known mastocytosis, the ratio of B12-to G5-measured tryptase was always < 5 and approached unity (Schwartz L. B., T. R. Bradford, C. Rouse, A.-M. Irani, G. Rasp, J. K. Van der Zwan and P.-W. G. . In this report, most mastocytosis patients with systemic disease have B12-measured tryptase levels that are elevated (> 20 ng/ml) and are at least 10-fold greater than the corresponding G5-measured tryptase level. Most of those subjects with B12-measured tryptase levels of < 20 ng/ml had only cutaneous manifestations. The B12 assay for a-tryptase and ,3-tryptase, particularly when performed in conjunction with the G5 assay for j8-tryptase, provides a more precise measure of mast cell involvement than currently available assessments, a promising potential screening test for systemic mastocytosis and may provide an improved means to follow disease progression and response to therapy. (J. Clin. Invest. 1995Invest. . 96:2702Invest. -2710

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Section: Resultsmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The alpha form of human tryptase is the predominant type present in blood at baseline in normal subjects and is elevated in those with systemic mastocytosis.

Schwartz¹,

Sakai²,

Bradford³

et al. 1995

J. Clin. Invest.

342

251

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“…After anaphylactic reactions to insect stings [22,23] or to drugs [24,25], tryptase levels in the blood peak at approximately 1 h. A recent paper found a significant in crease in serum tryptase after oral food challenges in chil dren [26]. However, the maximum increase was below 1 j.ig/1 350 Bcycr/Niggcmann/Schulzc/Wahn Tryptase and Methylhistamine in Oral Food Challenges…”

Section: Tryptasementioning

confidence: 99%

Serum Tryptase and Urinary 1-Methylhistamine as Parameters for Monitoring Oral Food Challenges in Children

Beyer¹,

Niggemann²,

Schulze³

et al. 1994

Int Arch Allergy Immunol

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To study the usefulness of urinary 1-methylhistamine and serum tryptase concentration as monitoring parameters in clinical settings, we investigated 32 children with atopic dermatitis and suspected food allergy during oral food challenges with eggs and cow’s milk. Urinary 1-methylhistamine (MH) excretion increased significantly within lh after positive oral food challenges (p < 0.006), but showed considerable variation in negative challenges. MH seems to be a sensitive parameter (92.8%), but its specifity is insufficient (37.7%). In the group of 16 positive oral food challenges serum tryptase concentration increased significantly (p < 0.02) directly after provocation and remained elevated up to 2 h after provocation. No variation was observed in negative challenges or nonatopic controls. Serum tryptase concentration seems to be specific for marked clinical reactions after oral food challenges (100%), but its sensitivity was low (25%) and not superior to evaluation by clinical means. We conclude that, despite positive results for the group of children, MH and serum tryptase concentrations are not useful parameters for monitoring oral food challenges in an individual child due to insufficient sensitivity and specificity.

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“…Although ␤-tryptase levels are undetectable in normal serum (Ͻ1 ng/ml), they are elevated in the blood of most cases of systemic anaphylaxis with hemodynamic compromise, particularly when the precipitating agent is administered parenterally. In such cases, the magnitude of mast cell degranulation appears to be the primary determinant of clinical severity (11)(12)(13). In contrast, based on mAbs that recognize both ␣-protryptase and ␤-tryptase, a total tryptase immunoassay was developed that detected levels of tryptase in baseline serum from essentially all individuals (mean Ϯ SD, 4.9 Ϯ 2.3 ng/ml) (14).…”

mentioning

confidence: 99%

Tryptase Precursors Are Preferentially and Spontaneously Released, Whereas Mature Tryptase Is Retained by HMC-1 Cells, Mono-Mac-6 Cells, and Human Skin-Derived Mast Cells

Schwartz

Min

Ren

et al. 2003

The Journal of Immunology

104

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Tryptase (α and β) levels in serum are used to assess mast cell involvement in human disease. Using cultured cells, the current study examines the hypothesis that protryptase(s) are spontaneously secreted by mast cells at rest, whereas mature tryptase(s) are stored in secretory granules until their release by activated cells. HMC-1 cells have only β-tryptase genes and the corresponding mRNA. Mono-Mac-6 cells have both α- and β-tryptase genes but preferentially express α-tryptase. Mono-Mac-6 cells spontaneously secrete most of their tryptase, which consists of α-protryptase, whereas mature tryptase is retained inside these cells. HMC-1 cells also spontaneously secrete most of their tryptase, identified as β-protryptase, and retain mature tryptase. Skin-derived mast cells retain most of their tryptase, which is mature, and spontaneously secrete protryptase(s). Total tryptase levels in plasma are detectable but no different in healthy subjects with and without the gene for α-tryptase, consistent with pro forms of both α- and β-tryptase being spontaneously secreted. Thus, protryptase(s) are spontaneously secreted by resting mast cells, whereas mature tryptase is retained by mast cells until they are activated to degranulate.

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Insect-sting challenge in 138 patients: Relation between clinical severity of anaphylaxis and mast cell activation†

Cited by 153 publications

References 30 publications

The alpha form of human tryptase is the predominant type present in blood at baseline in normal subjects and is elevated in those with systemic mastocytosis.

The alpha form of human tryptase is the predominant type present in blood at baseline in normal subjects and is elevated in those with systemic mastocytosis.

Serum Tryptase and Urinary 1-Methylhistamine as Parameters for Monitoring Oral Food Challenges in Children

Tryptase Precursors Are Preferentially and Spontaneously Released, Whereas Mature Tryptase Is Retained by HMC-1 Cells, Mono-Mac-6 Cells, and Human Skin-Derived Mast Cells

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