Allergy Asthma Immunol Res.  2014 Jul;6(4):304-309. 10.4168/aair.2014.6.4.304.

The Utility of Serum Tryptase in the Diagnosis of Food-Induced Anaphylaxis

• Wongkaewpothong P
• Pacharn P
• Sripramong C
• Boonchoo S
• Piboonpocanun S
• Visitsunthorn N
• Vichyanond P
• Jirapongsananuruk O

• KMID: 2260210
• DOI: http://doi.org/10.4168/aair.2014.6.4.304

Abstract

PURPOSE
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 microg/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 microg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was > or =0.8 microg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was > or =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.

Keyword

Anaphylaxis; food; tryptase; shrimp

MeSH Terms

Anaphylaxis*
Diagnosis*
Humans
Hypersensitivity
Skin
Tryptases*
Tryptases

Figure

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  Fig. 1 The change in the total tryptase in control, mild reaction and anaphylaxis groups during shrimp challenges. Baseline and peak tryptase values are designated by closed squares and closed triangulars, respectively. Horizontal bars indicate medians. NS: not significant.

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  Fig. 2 (A) Box plot of the delta-tryptase values (peak minus baseline tryptase) in control, mild reaction and anaphylaxis groups. (B) The box plot of tryptase ratio values (peak divided by baseline tryptase) in the control, mild reaction and anaphylaxis groups.

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  Fig. 3 Receiver-operator characteristics (ROC) curve analysis of peak serum tryptase, delta-tryptase and tryptase ratio for the diagnosis of anaphylaxis.

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