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Extending the role of tryptase in perioperative anaphylaxis: Predicting positive results in basophil activation tests.
Mak, Hugo W F; Au, Elaine Y L; Yeung, Maegan H Y; Chiang, Valerie; Lam, Ki; Wong, Jane C Y; Yeung, Heather H F; Chan, Eric Y T; Lau, Chak-Sing; Li, Philip H.
Afiliación
  • Mak HWF; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
  • Au EYL; Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
  • Yeung MHY; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
  • Chiang V; Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
  • Lam K; Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
  • Wong JCY; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
  • Yeung HHF; Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
  • Chan EYT; Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
  • Lau CS; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
  • Li PH; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
J Allergy Clin Immunol Glob ; 3(4): 100297, 2024 Nov.
Article en En | MEDLINE | ID: mdl-39176077
ABSTRACT

Background:

Basophil activation tests (BATs) are useful in identifying culprits of perioperative anaphylaxis (PA), but their utility remains limited due to technical limitations, cost, and availability. Being able to prioritize patients with likely higher yields for BAT would be useful in reducing costs and manpower.

Objective:

We sought to investigate whether tryptase levels and clinical parameters may be useful for selecting patients for BATs.

Methods:

We performed a 10-year retrospective study in Hong Kong to investigate the performance of BATs associated with tryptase levels (taking during PA) and other clinical parameters.

Results:

Of 90 patients, 70 (77.8%) showed significant tryptase level elevation and 37 (41.1%) had a positive BAT result. BAT-positive patients presented with significantly higher absolute levels (15.9 µg/L vs 9.1 µg/L; P = .018), absolute elevation (12.8 µg/L vs 7.1 µg/L; P = .012), and fold elevation (5.6- vs 4.1-fold; P = .014) of acute tryptase than did BAT-negative patients. Among patients with positive BAT result, 94.6% (35 of 37) demonstrated elevated acute tryptase, significantly more than the BAT-negative group (66.0%; P < .001). In regression analysis, tryptase elevation was the sole significant factor correlated to BAT positivity (odds ratio, 10.14; 95% CI, 2.15-47.85; P = .003). Overall, elevated acute tryptase demonstrated a sensitivity of 94.7% and a negative predictive value of 90.0% in predicting positive results with BATs.

Conclusions:

We observed that tryptase elevation is a very sensitive predictor of BAT positivity among patients with identified culprits of PA. Acute elevation of tryptase would not only aid in confirming anaphylaxis but may also help guide the decision toward selecting labor-intensive and costly in vitro tests such as BATs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Allergy Clin Immunol Glob Año: 2024 Tipo del documento: Article País de afiliación: Hong Kong Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Allergy Clin Immunol Glob Año: 2024 Tipo del documento: Article País de afiliación: Hong Kong Pais de publicación: Estados Unidos