ArticleThe Journal of allergy and clinical immunology2022
Defining baseline variability of serum tryptase levels improves accuracy in identifying anaphylaxis.
Article in The Journal of allergy and clinical immunology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers.
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Who cites it
36 citing papers in PubMed, 76 citations in OpenAlex.
- Understanding Tryptase Physiology, Clinical Significance, and Diagnostic Applications: Where Do We Stand?Biomolecules · 2026Review
- Periprocedural allergy evaluation is safe and effective to guide subsequent anesthesia administration.The journal of allergy and clinical immunology. Global · 2026Article
- Type II Kounis Syndrome Secondary to Amoxicillin Allergy.JACC. Case reports · 2026Article
- Successful treatment of refractory anaphylactic shock with angiotensin II: A case report.European journal of anaesthesiology and intensive care · 2026Article
- Hereditary Alpha-Tryptasemia (HαT) as a Risk Modifier for Severe Anaphylaxis.Immunology and allergy clinics of North America · 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
- 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
- Lactate in Anaphylaxis: 100 Years On.Sports medicine (Auckland, N.Z.) · 2025Review
- From Acute Carditis, Rheumatic Carditis, and Morphologic Cardiac Reactions to Allergic Angina, Allergic Myocardial Infarction, and Kounis Syndrome: A Multidisciplinary and Multisystem Disease.Journal of cardiovascular development and disease · 2025Review
- Pediatric anaphylaxis in the emergency department: Performances of dynamic tryptase measurement.The journal of allergy and clinical immunology. Global · 2025Article
- Hereditary alpha tryptasemia and clinical implications.World journal of clinical cases · 2025Review
- 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
- Pediatric Anaphylaxis in Emergency Care: A Detailed Analysis of Demographic and Laboratory Findings.Sisli Etfal Hastanesi tip bulteni · 2025Article
- Diagnostic Accuracy of Tryptase Levels for Pediatric Anaphylaxis: A Case-Control Study.International archives of allergy and immunology · 2025Article
- Defining "Normal" basal serum tryptase levels: a context-dependent approach to improve diagnostics in systemic mastocytosis.Frontiers in allergy · 2025Review
- Hereditary alpha-tryptasemia and monoclonal mast cell disorders.Frontiers in allergy · 2025Review
- Appraisal of the evidence linking hereditary α-tryptasemia with mast cell disorders, hypermobility and dysautonomia.Allergy and asthma proceedings · 2025Review
- Pediatric idiopathic anaphylaxis: practical management from infants to adolescents.Italian journal of pediatrics · 2024Review
- Mast cell activation syndrome: Current understanding and research needs.The Journal of allergy and clinical immunology · 2024Review
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundAcute increases of ≥20% + 2 ng/mL (20 + 2 rule) over basal serum tryptase (BST) is the recommended threshold supporting a clinical diagnosis of anaphylaxis. Prospective studies have demonstrated high sensitivity for this algorithm after parenteral exposure, but specificity has not been evaluated.
objectiveWe sought to define a serum tryptase change that distinguishes baseline variability from anaphylaxis on the basis of intraindividual variation in BST.
methodsNinety-three total subjects with atopy (n = 62) or hereditary α-tryptasemia (HαT) (n = 31) and ≥2 BST measurements were identified. Sequential BST variability measurements were modeled and threshold ratios that optimized sensitivity and/or specificity determined. Models were tested in 22 individuals with physician-diagnosed anaphylaxis and validated in independent cohorts of individuals with HαT (n = 33), indolent systemic mastocytosis (ISM) (n = 52), and ISM + HαT (n = 12). Mature tryptase levels were measured in HαT (n = 19) and ISM (n = 20). An online application was developed for clinical use.
resultsAs a result of BST variability, 9.7% (9/93) of primary cohort patients, and 18% (6/33) of HαT, 30% (16/53) of ISM, and 25% (3/12) of ISM + HαT patients from validation cohorts met the 20 + 2 rule despite absent immediate hypersensitivity symptoms; mature tryptase was noncontributory among individuals with HαT or ISM at baseline. A ratio of acute tryptase/BST exceeding 1.685 provided the optimized diagnostic rule for jointly maximizing sensitivity and specificity. Statistically significant improvement in specificity relative to the 20 + 2 rule was observed among individuals with elevated BST caused by HαT and ISM.
conclusionsUsing an acute tryptase/BST ratio of 1.685 improves specificity of measured changes among individuals with HαT and ISM while maintaining high sensitivity for confirmation of anaphylaxis.
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