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Title: The utility of serum tryptase in the diagnosis of food-induced anaphylaxis.
Authors: Patcharaporn Wongkaewpothong
Punchama Pacharn
Chaweewan Sripramong
Siribangon Boonchoo
Surapon Piboonpocanun
Nualanong Visitsunthorn
Pakit Vichyanond
Orathai Jirapongsananuruk
Mahidol University. Institute of Molecular Biosciences
Mahidol University. Faculty of Medicine Siriraj Hospital. Department of Pediatrics. Division of Allergy and Immunology
Keywords: Anaphylaxis;Food;Shrimp;Tryptase;Open Access article
Issue Date: 2014
Citation: Asthma and Immunology Research. Vol.6, No.4 (2014), 304-309
Abstract: This study investigates the utility of serum tryptase for the confirmation of shrimp-induced anaphylaxis. METHODS: Patients with a history of shrimp allergy and positive skin prick tests (SPT) to commercial shrimp extract were recruited for shrimp challenges. Serum total tryptase was obtained at baseline and 60 min (peak) after the onset of symptoms. RESULTS: Thirty-nine patients were challenged. There were 12 patients with anaphylaxis, 20 with mild reactions and 7 without symptoms (control group). Characteristic features and baseline tryptase were not different among the 3 groups. The peak tryptase levels were higher than the baseline in anaphylaxis and mild reaction groups (P<0.05). The delta-tryptase (peak minus baseline) and the tryptase ratio (peak divided by baseline) in the anaphylaxis group were higher than the mild reaction and control groups (P<0.01). The optimum cut-off for peak tryptase to confirm anaphylaxis was 2.99 µg/L with 50% sensitivity, 85% specificity, 3.33 positive likelihood ratio (LR) and 0.59 negative LR. The manufacturer's cut-off for peak tryptase was >11.4 µg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was ≥0.8 µg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was ≥1.5 with 92% sensitivity, 96% specificity, 23 positive LR and 0.08 negative LR. CONCLUSIONS: The peak tryptase level should be compared with the baseline value to confirm anaphylaxis. The tryptase ratio provide the best sensitivity, specificity, positive and negative LR than a single peak serum tryptase for the confirmation of shrimp-induced anaphylaxis.
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