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Medline ® Abstract for Reference 33

of 'Laboratory tests to support the clinical diagnosis of anaphylaxis'

Tryptase levels in children presenting with anaphylaxis: Temporal trends and associated factors.
De Schryver S, Halbrich M, Clarke A, La Vieille S, Eisman H, Alizadehfar R, Joseph L, Morris J, Ben-Shoshan M
J Allergy Clin Immunol. 2016;137(4):1138.
BACKGROUND: The diagnosis of anaphylaxis currently relies on suggestive clinical history after exposure to a potential triggering factor because no reliable diagnostic marker is available to confirm the diagnosis.
OBJECTIVES: We aimed to evaluate tryptase levels in children with anaphylaxis and to examine predictors of elevated tryptase level (defined as≥11.4 μg/L during reaction and for those with a baseline level, defined as a reaction level of at least 2 ng/mL + 1.2 × [postreaction tryptase level]).
METHODS: Children presenting with anaphylaxis to the Montreal Children's Hospital were recruited over a 4-year period. Symptoms, triggers, and management of anaphylaxis were documented. Levels during the reaction and approximately 9 months after the reaction were compared on the basis of paired means using the t distribution. Multivariate linear and logistic regressions were used to evaluate the association between tryptase levels and risk factors.
RESULTS: Over a 4-year period, 203 children had serum tryptase levels measured. Among these, 39 children (19.2%; 95% CI, 14.1%-25.4%) had elevated levels. Only severe reactions were associated with reaction levels of 11.4 μg/L or more (odds ratio, 6.5; 95% CI, 2.2-19.0). Milk-induced anaphylaxis and severe reactions were more likely associated with increased tryptase levels (beta-adjusted, 4.0; 95% CI, 0.95-7.0, and 7.5; 95% CI, 4.8-10.3, respectively). Reaction levels exceeding the threshold level of 2 ng/mL + 1.2 × (postreaction tryptase level) detected most of the anaphylactic reactions, particularly if baseline levels were taken within 2 months of the reaction.
CONCLUSIONS: Tryptase levels are particularly useful for the diagnosis of severe and/or milk-induced anaphylaxis. Assessing the difference between reaction and postreaction tryptase levels may improve diagnostic sensitivity.
Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.