JOPIC

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine.

EndNote Style
Index
Original Article
Evaluation of tryptase levels in anaphylaxis
Aims: Tryptase is a serine protease released from mast cells during an acute allergic reaction. Levels of serum tryptase vary among healthy individuals, and there has been a growing debate about the normal and abnormal ranges of tryptase depending on the numbers of mast cells, basal secretion rate, and renal function. To adress this point, serum tryptase levels were analysed in subjects with a prediagnosis or absolute diagnosis of anaphylaxis.
Methods: This was a retrospective, one-centered study performed in a Tertiary Hospital in Turkey. Patient recruiment criteria was that files of patients with tryptase levels between 2020 and 2023 were evaluated detailly. Serum tryptase levels that is moment at reaction (RT) and as basal (BT) were analyzed with the same method with ImmunoCAP (Pharmacia, Uppsala, Sweden). The age, gender and reasons for admission of the patients were examined one by one.
Results: Out of approximately 400 test entries, there were valid results of 300. A ratio of 62% of the patients were female (n: 186) and 38% were male (n: 114). The mean age was 18-89 (41.5±14.7)/year. Serum levels of tryptase was measured at the time of reaction in 12.7% of the patients, 4.3% had both reaction and baseline tryptase levels, and the rest had only baseline tryptase analyses. A statistically significant difference was found between the tryptase levels during the reaction in males and females (p: 0.02, Female/Male: 7.26±4.91/16.93±11.11 µg/L). We found that approximately 90.3% of the patients had serum tryptase levels lower than 11.5 µg/L. There was a statistically significant difference between reaction time (RT) and baseline tryptase (BT) in drug-induced hypersensitivity reactions (p: 0.02), but no difference was found in venom hypersensitivity reactions (p: 0.47). There was no correlation between age and tryptase during reaction, but a positive correlation was found between baseline tryptase (p: 0.01 r: 0.162).
Conclusion: There may be many reasons for high serum tryptase levels. For doctors, it is important to quickly recognize anaphylaxis and manage the treatment process quickly. In this study, we reviewed all tryptase results retrospectively and addressed the etiology of the cases we encountered in our center. We showed that age is a baseline variable in determining tryptase levels. Tryptase can be used as a useful biomarker in diagnosis.


1. Orhan F, Canitez Y, Bakirtas A, et al., Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy. 2011;41(12): 1767-1776. doi:10.1111/j.1365-2222.2011.03859.x
2. Gelincik A, Demirtürk M, Yılmaz E, et al., Anaphylaxis in a tertiary adult allergy clinic: a retrospective review of 516 patients. Ann Allergy Asthma Immunol. 2013;110(2):96-100. doi:10.1016/j.anai.2012.11.018
3. Jogie-Brahim S, Min HK, Fukuoka Y, Xia HZ, Schwartz LB. Expression of α-tryptase and β-tryptase by human basophils. J Allergy Clin Immunol. 2004;113(6):1086-1092. doi:10.1016/j.jaci.2004.02.032
4. Schwartz L, Lewis RA, Austen K. Tryptase from human pulmonary mast cells. Purification and characterization. J Biol Chem. 1981;256(22): 11939-11943.
5. Sakai K, Ren S, Schwartz LB. A novel heparin-dependent processing pathway for human tryptase. Autocatalysis followed by activation with dipeptidyl peptidase I. J Clin Invest. 1996;97(4):988-995. doi:10.1172/JCI 118523
6. Wong GW, Yasuda S, Madhusudhan MS, et al., Human tryptase ε (PRSS22), a new member of the chromosome 16p13. 3 family of human serine proteases expressed in airway epithelial cells. J Biol Chem. 2001; 276(52):49169-49182. doi:10.1074/jbc.M108677200
7. Caughey GH. Tryptase genetics and anaphylaxis. J Allergy Clin Immunol. 2006;117(6):1411-1414. doi:10.1016/j.jaci.2006.02.026
8. Lyons JJ. Inherited and acquired determinants of serum tryptase levels in humans. Ann Allergy Asthma Immunol. 2021;127(4):420-426. doi:10. 1016/j.anai.2021.06.019
9. Schwartz LB, Min HK, Ren S, et al., 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. J Immunol. 2003;170(11):5667-5673. doi:10.4049/jimmunol. 170.11.5667
10. Schwartz LB, Bradford TR, Rouse C, et al., Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis. J Clin Immunol. 1994;14(3):190-204. doi:10.1007/BF01533368
11. Passia E,Jandus P. Using baseline and peak serum tryptase levels to diagnose anaphylaxis: a review. Clin Rev Allergy Immunol. 2020;58(3): 366-376. doi:10.1007/s12016-020-08777-7
12. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006;26(3):451-463. doi: 10.1016/j.iac.2006.05.010
13. Baççıoğlu A, Yılmazel Uçar E. Level of knowledge about anaphylaxis among health care providers. Tuberk Toraks. 2013;61(2):140-146. doi:10. 5578/tt.4812
14. Dumanoglu B, Alpagat G, Poyraz M, Alan Yalim S, Baccioglu A. Anaphylaxis after consumption of guar gum-containing food: a report of two cases. Cureus. 2022;14(8):e28022. doi:10.7759/cureus.28022
15. Sampson HA, Muñoz-Furlong A, Campbell RL, et al., Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397. doi:10.1016/j.jaci.2005.12.1303
16. Hogan AD, Schwartz LB. Markers of mast cell degranulation. Methods. 1997;13(1):43-52. doi:10.1006/meth.1997.0494
17. Simons FE, Sheikh A. Evidence-based management of anaphylaxis. Allergy. 2007;62(8):827-829. doi:10.1111/j.1398-9995.2007.01433.x
18. Orhan F, Civelek E, Şahiner Ü. Anafilaksi: Türk Ulusal Rehberi 2018. Asthma Allergy Immunol. 2018;16:1. doi:10.21911/aai.2018.1
19. Rusznak C, Peebles RS Jr. Anaphylaxis and anaphylactoid reactions. A guide to prevention, recognition, and emergent treatment. Postgrad Med. 2002;111(5):101-104. doi:10.3810/pgm.2002.05.1207
20. Edston E,Van Hage-Hamsten M.Beta-tryptase measurements post-mortem in anaphylactic deaths and in controls.Forensic Sci Int. 1998; 93(2-3):135-142. doi:10.1016/s0379-0738(98)00040-1
21. Pumphrey RS,Roberts IS.Postmortem findings after fatal anaphylactic reactions. J Clin Pathol.2000;53(4):273-276. doi:10.1136/jcp.53.4.273
22. Enrique E, García-Ortega P, Sotorra O, Gaig P, Richart C. Usefulness of UniCAP-tryptase fluoroimmunoassay in the diagnosis of anaphylaxis. Allergy. 1999;54(6):602-606. doi:10.1034/j.1398-9995.1999.00882.x
23. Valent P, Hartmann K, Bonadonna P, et al. Global classification of mast cell activation disorders: an ICD-10-CM-adjusted proposal of the ECNM-AIM consortium. J Allergy Clin Immunol Pract. 2022;10:1941-1950. doi:10.1016/j.jaip.2022.05.007.
24. Nakahata T, Toru H. Cytokines regulate development of human mast cells from hematopoietic progenitors.Int J Hematol. 2002;75(4):350-356. doi:10.1007/BF02982123
25. Lyons JJ, Sun G, Stone KD, et. al.: Mendelian inheritance of elevated serum tryptase associated with atopy and connective tissue abnormalities. JAllergy Clin Immunol. 2014;133(5):1471-1474. doi:10. 1016/j.jaci.2013.11.039
26. Akin C, Valent P, Metcalfe DD. Mast cell activation syndrome: proposed diagnostic criteria. JAllergy Clin Immunol. 2010;126(6):1099-104.e4. doi:10.1016/j.jaci.2010.08.035
27. Beyens M, Toscano A, Ebo D, Gülen T, Sabato V. Diagnostic significance of tryptase for suspected mast cell disorders. Diagnostics (Basel). 2023;13(24):3662. doi:10.3390/diagnostics13243662
28. Schwartz LB, Metcalfe DD, Miller JS, Earl H, Sullivan T. Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis. N Engl J Med. 1987;316(26):1622-1626. doi:10.1056/NEJM 198706253162603
29. Lyons JJ. Inherited and acquired determinants of serum tryptase levels in humans. Ann Allergy Asthma Immunol. 2021;127(4):420-426. doi:10. 1016/j.anai.2021.06.019
30. Vos BJ, Van der Veer E, Van Voorst Vader PC, et al. Diminished reliability of tryptase as risk indicator of mastocytosis in older overweight subjects. J Allergy Clin Immunol. 2015;135(3):792-798. doi: 10.1016/j.jaci.2014.05.047
31. Lee AYS. Elevated serum tryptase in non-anaphylaxis cases: a concise review. Int Arch Allergy Immunol. 2020;181(5):357-364. doi:10.1159/ 000506199
32. Beceiro C, Campos J, Valcarcel MA, et al. Serum concentrations of mast cell tryptase are reduced in heavy drinkers. Alcohol Clin Exp Res. 2015;39(4):672-678. doi:10.1111/acer.12682
33. Small-Howard A, Turner H. Exposure to tobacco-derived materials induces overproduction of secreted proteinases in mast cells. Toxicol Appl Pharmacol. 2005;204(2):152-163. doi:10.1016/j.taap.2004.09.003
34. Schussler E, Yang A, Lyons JJ, Milner JD, Wang J. Persistent tryptase elevation in a patient with Gaucher disease. J Allergy Clin Immunol Pract. 2018;6(2):697-699. doi:10.1016/j.jaip.2017.08.039
35. Van Toorenenbergen AW, van Daele PL, Boonstra JG. False-elevated serum tryptase assay result caused by heterophilic antibodies. J Allergy Clin Immunol. 2005;116(5):1159-1160. doi:10.1016/j.jaci.2005.07.023
36. Bulut İ, Yegin Katran Z, Yavuz D. Anaphylaxis in a country where Asia and Europe meet: evaluation according to World Allergy Organization (WAO) and European Academy of Allergy and Clinical Immunology (EAACI) diagnostic criteria. World Allergy Organ J. 2024;17(9):100962. doi:10.1016/j.waojou.2024.100962
37. Romano A, Atanaskovic-Markovic M, Barbaud A, et al. Towards a more precise diagnosis of hypersensitivity to beta-lactams-an EAACI position paper. Allergy. 2020;75(6):1300-1315. doi:10.1111/all.14122
38. Joint Task Force on Practice Parameters; American Academy of Allergy Asthma and Immunology; American college of allergy, asthma and Immunology; joint council of allergy, asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273. doi: 10.1016/j.anai.2010.08.002. PMID: 20934625.
39. Turner PJ, Ansotegui IJ, Campbell DE, et al. WAO anaphylaxis committee and WAO allergen immunotherapy committee. Updated grading system for systemic allergic reactions: joint statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee. World Allergy Organ J. 2024;17(3):100876. doi:10.1016/j.waojou.2024.100876
40. Demir S, Erdenen F, Gelincik A, et al. Evaluation of the potential risk factors for drug-induced anaphylaxis in adult patients. Int Arch Allergy Immunol. 2019;178(2):167-176. doi:10.1159/000494130
41. Slot MC, Claessen LHJ, Bons JAP, Menheere PPCA, Nieuwhof CMG, de Boer D. Tryptase reference ranges are age-dependent in a large population-based cohort.Allergy. 2022;77(9):2833-2834. doi:10.1111/all. 15369
42. Low AE, McEwan JC, Karanam S, North J, Kong KL. Anaesthesia-associated hypersensitivity reactions: seven years’ data from a British bi-specialty clinic. Anaesthesia. 2016;71(1):76-84. doi:10.1111/anae.13273
43. Sala-Cunill A,Cardona V,Labrador-Horrillo M, etal.Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients.Int Arch Allergy Immunol. 2013;160(2):192-199. doi:10.1159/000339749
44. Tejedor-Alonso MA, Moro-Moro M, Múgica-García MV. Epidemiology of anaphylaxis: contributions from the last 10 years. JInvestig Allergol Clin Immunol. 2015;25(3):163-175.
45. Seitz CS, Brockow K, Hain J, Trautmann A. Non-steroidal anti-inflammatory drug hypersensitivity: association with elevated basal serum tryptase? Allergy Asthma Clin Immunol. 2014;10(1):19. doi:10. 1186/1710-1492-10-19
46. Bonadonna P, Scaffidi L, Boni E. Tryptase values in anaphylaxis and insect allergy. Curr Opin Allergy Clin Immunol. 2019;19(5):462-467. doi: 10.1097/ACI.0000000000000569
47. Yunginger JW, Nelson DR, Squillace DL, et al. Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci. 1991;36(3):857-865.
48. Bengstonn U, Hanson LA, Ahlstedt S. Survey of gastrointestinal reactions to food in adults in relation to atopy, presence of mucus in stools, swelling of joints and arthralgia in patients with gastrointestinal reactions to food. Clin Exp Allergy. 1996;26(12):1387-1394. doi:10. 1111%2Fj.1365-2222.1996.tb00540.x
49. Lieberman PL: Anaphylaxis; in Adkinson NF Jr, Bochner BS, Busse WW, Holgate ST, Lemanske RF Jr, Simons FER (eds): Middleton’s allergy: principles and practice, ed 7. St. Louis, Mosby, 2009.
Volume 3, Issue 3, 2025
Page : 48-52
_Footer