Pretreatment with Methylprednisolone in Coronary Artery Bypass Grafting Influences the Levels of Histamine and Tryptase in Serum but Not in Bronchoalveolar Lavage Fluid

Abstract

1. The presence of histamine and tryptase in serum during and after coronary artery bypass grafting may be an indication of the induction of inflammation. 2. One group of patients received no glucocorticoids and a second group received methylprednisolone before extracorporeal circulation. In the steroid group no effects were seen on the basal levels of histamine (2.84 + 0.12 ng/ml) and tryptase (030 + 0.05 ng/ml) during and after surgery. In the other group two peak levels of histamine were observed: one at 10 min after starting extracorporeal circulation (4.19 +1.79 ng/ml) and another at 4h after surgery (8.26 +4.85 ng/ml). In this group tryptase was only elevated during the period of extracorporeal circulation (1.54+ 0.16 ng/ml). 3. There were no differences between the two groups in complement activation. C3a levels rose to 170 +8% and 180 +10% of the initial value in the steroid and non-steroid group, respectively. 4. It was concluded that during surgery mast cells were activated, but since tryptase levels decreased in the post-operative period, the second increase in the histamine level can be explained by activation of basophils or by an unknown mechanism for the release of histamine but not tryptase by mast cells. 5. In the bronchoalveolar lavage fluid the levels of histamine and tryptase showed no differences between the two groups of patients, but histamine was enhanced compared with normal levels.

Steroid use before pediatric cardiac operations using cardiopulmonary bypass: An international survey of 36 centers*

“…This practice is supported by pediatric (5,6,8,10) and adult (12)(13)(14)(15)(16)(17) studies. On the other hand, although approximately one third of the centers surveyed administer a single steroid dose in the circuit prime, this practice has not been studied in either animals or humans.…”

The Normal Range of Baseline Tryptase Should Be 1 to 15 ng/mL and Covers Healthy Individuals With HαT

“…[42][43][44]49,[54][55][56]63 In patients receiving corticosteroids (systemic or topical), BST levels may decrease. [64][65][66] For example, Schlag et al 66 reported that, in patients with eosinophilic esophagitis, topical therapy with fluticasone (500 mg twice daily) resulted in a decrease of tryptase levels from 4.7 ng/mL to 3.8 ng/mL. In general, such drug effects may be an issue in patients with anaphylaxis in which eventrelated tryptase levels and post-event (basal) tryptase levels should be compared to define whether MCAS criteria are met.…”

Modulation of Systemic Inflammatory Response after Cardiac Surgery

“…169 However, the ability of corticosteroid pretreatment to attenuate post-CPB pulmonary inflammation, endotoxemia, and complement activation is disputed. 161,165,170–171 The clinical implications of corticosteroid use are not yet fully elucidated, and clear benefit is not yet demonstrated. The dosage, formulation, and timing of administration of corticosteroids may be critical, and differences in dosage regimens may explain conflicting results.…”