Joana Vitte1, Laurent Amadei2, Marion Gouitaa3, Soraya Mezouar1, Laurent Zieleskiewicz2, Jacques Albanese4, Nicolas Bruder5, David Lagier5, Paul M Mertès6, Jean-Louis Mège1, Lawrence B Schwartz7, Marc Leone1,2. 1. Aix-Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France. 2. Aix-Marseille Univ, APHM, Hôpital Nord, Marseille, France. 3. Aix-Marseille Univ, APHM, Hôpital Nord, Service de Pneumologie, Marseille, France. 4. Aix-Marseille Univ, APHM, Hôpital de la Conception, Service d'Anesthésie et de Réanimation, Marseille, France. 5. Aix-Marseille Univ, APHM, Hôpital de la Timone, Service d'Anesthésie et de Réanimation, Marseille, France. 6. Strasbourg Univ, HUS, Nouvel Hôpital Civil, FMTS, Service d'Anesthésie Réanimation, Strasbourg, France. 7. Division of Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, Virginia, VA, USA.
Abstract
BACKGROUND: Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination. METHODS: A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured. RESULTS: Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than ([1.2×baseline tryptase] + 2] μg/L to be considered a clinically significant rise. In our cohort, this algorithm achieved 94% positive predictive value (PPV), 53% negative predictive value (NPV), 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis. CONCLUSION: Total tryptase levels in serum discriminated between nonanaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.
BACKGROUND: Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination. METHODS: A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured. RESULTS: Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than ([1.2×baseline tryptase] + 2] μg/L to be considered a clinically significant rise. In our cohort, this algorithm achieved 94% positive predictive value (PPV), 53% negative predictive value (NPV), 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis. CONCLUSION: Total tryptase levels in serum discriminated between nonanaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.
Authors: Allyson Mateja; Qinlu Wang; Jack Chovanec; Jiwon Kim; Kenneth J Wilson; Lawrence B Schwartz; Sarah C Glover; Melody C Carter; Dean D Metcalfe; Erica Brittain; Jonathan J Lyons Journal: J Allergy Clin Immunol Date: 2021-08-20 Impact factor: 14.290
Authors: Dirceu Solé; Maria Anita Costa Spindola; Marcelo Vivolo Aun; Liana Maria Tôrres de Araújo Azi; Luiz Antonio Guerra Bernd; Daniela Bianchi Garcia; Albertina Varandas Capelo; Débora de Oliveira Cumino; Alex Eustáquio Lacerda; Luciana Cavalcanti Lima; Edelton Flávio Morato; Rogean Rodrigues Nunes; Norma de Paula Motta Rubini; Jane da Silva; Maria Angela Tardelli; Alexandra Sayuri Watanabe; Erick Freitas Curi; Flavio Sano Journal: Braz J Anesthesiol Date: 2020-11-09
Authors: Maria Anita Costa Spindola; Dirceu Solé; Marcelo Vivolo Aun; Liana Maria Tôrres de Araújo Azi; Luiz Antonio Guerra Bernd; Daniela Bianchi Garcia; Albertina Varandas Capelo; Débora de Oliveira Cumino; Alex Eustáquio Lacerda; Luciana Cavalcanti Lima; Edelton Flávio Morato; Rogean Rodrigues Nunes; Norma de Paula Motta Rubini; Jane da Silva; Maria Ângela Tardelli; Alexandra Sayuri Watanabe; Erick Freitas Curi; Flávio Sano Journal: Braz J Anesthesiol Date: 2020-09-17