ReviewInternational archives of allergy and immunology2019
Why the 20% + 2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome.
Review in International archives of allergy and immunology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers.
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Who cites it
60 citing papers in PubMed, 132 citations in OpenAlex.
- Assessment of fluorescence interference in the basophil activation test: a case of indocyanine green-induced anaphylaxis.Journal of anesthesia · 2026Article
- Understanding Tryptase Physiology, Clinical Significance, and Diagnostic Applications: Where Do We Stand?Biomolecules · 2026Review
- [Clinical aspects and diagnostics of mast cell-mediated angioedemas].Dermatologie (Heidelberg, Germany) · 2026Article
- Mast cell activation syndrome-related unusual periocular inflammation associated with mydriatic eyedrops during cataract surgery.American journal of ophthalmology case reports · 2026Article
- Hereditary Alpha-Tryptasemia (HαT) as a Risk Modifier for Severe Anaphylaxis.Immunology and allergy clinics of North America · 2026Review
- Markedly Increased Diamine Oxidase During Acute Anaphylaxis Is Associated With an Underlying Clonal Mast Cell Disorder.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Article
- Characteristics and outcomes of patients with pediatric-onset non-mastocytosis mast cell activation disorders: A CEREMAST study.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
- Diagnostic Performance of Biomarkers for Perioperative Hypersensitivity Reactions in Adults: A Systematic Review and Meta-Analysis on Tryptase and Histamine Dosing.Diagnostics (Basel, Switzerland) · 2026Review
- Mast Cell Mediators and Their Diagnostic Utility in Clonal and Nonclonal Mast Cell Activation Disorders.Current allergy and asthma reports · 2026Review
- Hereditary Alpha-Tryptasemia and Mastocytosis: What We Know and What We Need To Learn.Current allergy and asthma reports · 2026Review
- Gut-Brain Inflammation and Disrupted Homeostasis Due to Activation of Mast Cells and Microglia.International journal of molecular sciences · 2026Review
- Diagnosis and management of mast cell activation syndrome (MCAS) in Canada: a practical approach.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Review
- Role of Mast Cells and Their Mediators in Chronic Kidney Diseases.International journal of molecular sciences · 2025Review
- Pediatric anaphylaxis in the emergency department: Performances of dynamic tryptase measurement.The journal of allergy and clinical immunology. Global · 2025Article
- Acute/baseline ratios of all 3 MC mediator metabolites can enhance diagnosis and management of mast cell activation syndrome.The journal of allergy and clinical immunology. Global · 2025Article
- Diagnostic Accuracy of Tryptase Levels for Pediatric Anaphylaxis: A Case-Control Study.International archives of allergy and immunology · 2025Article
- Basophil activation test is a complementary tool in the diagnosis of immediate reactions to platinum salts and taxanes.Allergy · 2025Article
- Appraisal of the evidence linking hereditary α-tryptasemia with mast cell disorders, hypermobility and dysautonomia.Allergy and asthma proceedings · 2025Review
- Clustering of clinical symptoms using large language models reveals low diagnostic specificity of proposed alternatives to consensus mast cell activation syndrome criteria.The Journal of allergy and clinical immunology · 2025Article
- Defining "Normal" basal serum tryptase levels: a context-dependent approach to improve diagnostics in systemic mastocytosis.Frontiers in allergy · 2025Review
Corrections and comments
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Authors and funding
12 authors at 11 institutions in 8 countries.
Funding
Abstract
Mast cell activation syndrome (MCAS) is a condition characterized by recurrent episodes of clinically relevant, systemic, severe reactions to mast cell (MC)-derived mediators released in the context of anaphylaxis or another acute MC-related event. It is important to document MC involvement in these reactions in order to establish the diagnosis MCAS. The most specific and reliable marker of systemic MC activation is an acute and substantial event-related (transient) increase in the serum tryptase level over the individual's baseline value. However, the baseline level of tryptase varies depending on the underlying disease and the genetic background. For example, an estimated 3-5% of healthy individuals exhibit duplications or multiple copies of the TPSAB1 gene encoding for alpha-tryptase, and over 30% of all patients with myeloid neoplasms, including mastocytosis, have elevated basal tryptase levels. Therefore, it is of utmost importance to adjust the event-related diagnostic (MCAS-confirming) increase in tryptase over the individual baseline in a robust approach. To address this challenge, the 20% + 2 formula was proposed by the consensus group in 2012. Since then, this approach has been validated in clinical practice by independent groups and found to be sound. In the current article, we discuss the emerging importance and value of the 20% + 2 formula in clinical practice and its role as a criterion of severe systemic MC activation and MCAS.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.