Causes and Diagnostic Usefulness of Tryptase Measurements for Anaphylaxis in a Korean Tertiary Care General Hospital

다국어 초록 (Multilingual Abstract)

Purpose: The causes of anaphylaxis in a general hospital may differ from those occurring in a community setting. Underlying diseases in admitted patients and vague presenting symptoms can make the diagnosis of anaphylaxis difficult. Serum tryptase measurements may provide valuable evidence for diagnosing anaphylaxis in admitted patients.
Materials and Methods: This study was designed as a retrospective study of 53 patients with an anaphylaxis episode at a Korean tertiary care general hospital. Tryptase levels were measured at baseline and different time points from the onset of anaphylaxis.
Results: Drugs (42 cases; 79.2%) and foods (10 cases; 18.9%) were the most common causes of anaphylaxis. In drug-induced anaphylaxis, antibiotics (24.5%), anticancer medications, which included monoclonal antibodies (22.6%), and contrast agents (11.3%) were the most frequent causes. The muscle relaxant eperisone (5.7%), neuromuscular blocking agent rocuronium (5.7%), and its antagonist sugammadex (3.8%) were other frequent triggering agents. Wheat-dependent exercise-induced anaphylaxis was the most common entity in food-induced anaphylaxis. Tryptase concentrations were higher in patients with higher grades of anaphylaxis, as well as in accidental anaphylaxis, compared to meticulously provoked anaphylaxis. Overall diagnostic sensitivity was higher for tryptase algorithm criteria (≥[1.2×baseline+2] µg/L: 71.4%) than for abnormal tryptase level criteria (≥11.4 µg/L: 52.8%).
Conclusion: The triggers of anaphylaxis in a Korean tertiary care hospital were diverse, including beta-lactam antibiotics, anticancer medications, contrast medias, eperisone, nonsteroidal anti-inflammatory drugs, rocuronium, sugammadex, and wheat. Tryptase measurements provided valuable evidence for diagnosis, and the sensitivity of algorithm criteria was superior to that of the abnormal value criteria.

참고문헌 (Reference)

1 Simons FE, "World Allergy Organization anaphylaxis guidelines : 2013 update of the evidence base" 162 : 193-204, 2013

2 Cardona V, "World Allergy Organization anaphylaxis guidance 2020" 13 : 100472-, 2020

3 Sala-Cunill A, "Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients" 160 : 192-199, 2013

4 Schwartz LB, "Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis" 316 : 1622-1626, 1987

5 Komericki P, "Tryptase as severity marker in drug provocation tests" 140 : 164-169, 2006

6 Yu JE, "The epidemiology of anaphylaxis" 54 : 366-374, 2018

7 Egner W, "Specialist perioperative allergy clinic services in the UK 2018 : results from the Royal College of Anaesthetists Sixth National Audit Project(NAP6)investigation of perioperative anaphylaxis" 48 : 846-861, 2018

8 예영민 ; 김미경 ; 강혜련 ; 김태범 ; 손성욱 ; 고영일 ; 박혜경 ; 장광천 ; 김철우 ; 지영구 ; 허규영 ; 김주희 ; 김상헌 ; 최길순 ; 이수걸 ; 박해심, "Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study" 대한천식알레르기학회 7 (7): 22-29, 2015

9 Cahill KN, "Plasma tryptase elevation during aspirin-induced reactions in aspirinexacerbated respiratory disease" 143 : 799-803.e2, 2019

10 Vitte J, "Paired acute-baseline serum tryptase levels in perioperative anaphylaxis : an observational study" 74 : 1157-1165, 2019

11 Sheldon J, "Laboratory investigation of anaphylaxis : not as easy as it seems" 70 : 1-5, 2015

12 Ring J, "Incidence and severity of anaphylactoid reactions to colloid volume substitutes" 1 : 466-469, 1977

13 Thermo Fisher Scientific Inc, "ImmunoCAP tryptase. Directions for use [Internet]"

14 Lieberman PL, "Idiopathic anaphylaxis" 35 : 17-23, 2014

15 Vitte J, "Human mast cell tryptase in biology and medicine" 63 : 18-24, 2015

16 Waterfield T, "How to interpret mast cell tests" 101 : 246-251, 2016

17 Jerschow E, "Fatal anaphylaxis in the United States, 1999-2010 : temporal patterns and demographic associations" 134 : 1318-1328.e7, 2014

18 박경희 ; 이상철 ; 육지은 ; 김성렬 ; 이재현 ; 박중원, "Eperisone-Induced Anaphylaxis: Pharmacovigilance Data and Results of Allergy Testing" 대한천식알레르기학회 11 (11): 231-240, 2019

19 Stone SF, "Elevated serum cytokines during human anaphylaxis : identification of potential mediators of acute allergic reactions" 124 : 786-792.e4, 2009

20 Muraro A, "EAACI guidelines : anaphylaxis(2021 update)" 77 : 357-377, 2022

21 Brockow K, "Detection of drug-specific immunoglobulin E(IgE)and acute mediator release for the diagnosis of immediate drug hypersensitivity reactions" 496 : 113101-, 2021

22 Valent P, "Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes : a consensus proposal" 157 : 215-225, 2012

23 Cho H, "Common causes of emergency department visits for anaphylaxis in Korean community hospitals : a cross-sectional study" 98 : e14114-, 2019

24 Sim DW, "Clinical characteristics of adverse events associated with therapeutic monoclonal antibodies in Korea" 25 : 1279-1286, 2016

25 Ewan PW, "BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia" 40 : 15-31, 2010

26 Brereton A, "Anaphylaxis to muscle relaxants : an audit of ten years of allergy testing at the Royal Adelaide Hospital" 40 : 861-866, 2012

27 Castells MC, "Anaphylaxis to chemotherapy and monoclonal antibodies" 35 : 335-348, 2015

28 Simons FE, "Anaphylaxis pathogenesis and treatment" 66 (66): 31-34, 2011

29 Wood RA, "Anaphylaxis in America : the prevalence and characteristics of anaphylaxis in the United States" 133 : 461-467, 2014

30 Raisch DW, "Anaphylaxis associated with gadolinium-based contrast agents : data from the Food and Drug Administration’s Adverse Event Reporting System and review of case reports in the literature" 13 : 15-23, 2014

31 Jeong K, "A multicenter anaphylaxis registry in Korea : clinical characteristics and acute treatment details from infants to older adults" 13 : 100449-, 2020

32 이지호 ; 리원연 ; 신계철 ; 용석중 ; 이명규 ; 김상하 ; 김충환, "A Case of Levofloxacin-Induced Anaphylaxis With Elevated Serum Tryptase Levels" 대한천식알레르기학회 5 (5): 113-115, 2013