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Allergy screening Tryptase
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Measures tryptase enzyme released from mast cells.
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Allergy Screening Tryptase - Comprehensive Medical Test Guide
- Why is it done?
- Measures serum tryptase, an enzyme released by mast cells and basophils during allergic reactions and anaphylaxis
- Diagnose anaphylaxis: Elevated tryptase levels during or shortly after suspected anaphylactic episodes help confirm mast cell degranulation
- Identify mast cell disorders: Baseline elevated tryptase may indicate systemic mastocytosis or other mast cell-related conditions
- Evaluate recurrent allergic reactions: Helps differentiate true IgE-mediated allergies from other causes of symptoms
- Assess food, drug, or insect sting allergy severity: Elevated baseline tryptase predicts more severe reactions
- Timing: Samples collected during acute symptoms or within 15 minutes to 3 hours after anaphylaxis onset are most diagnostic; baseline samples obtained when patient is asymptomatic for comparison
- Normal Range
- Normal baseline tryptase: Less than 11.4 ng/mL or mcg/L (laboratory-specific reference ranges typically vary from 0 to 11.4 ng/mL)
- Units: Nanograms per milliliter (ng/mL) or micrograms per liter (mcg/L)
- Interpretation guide:
- Less than 11.4 ng/mL: Normal baseline tryptase; suggests no underlying mast cell disorder
- 11.4 to 20 ng/mL: Borderline elevated or slightly elevated; may warrant further investigation
- Greater than 20 ng/mL: Significantly elevated; suggests mast cell activation, possible systemic mastocytosis, or mast cell disorders
- Acute elevation during anaphylaxis: Tryptase levels increase 1.2 times or more from baseline (threefold increase highly suggestive of anaphylaxis)
- Negative result: Tryptase within normal baseline range rules out anaphylaxis if tested during acute event; does not exclude IgE-mediated allergy
- Interpretation
- Acute elevated tryptase (>1.2 x baseline or >11.4 ng/mL during symptoms): Indicates recent mast cell degranulation; highly suggestive of anaphylaxis, especially if baseline comparison available
- Persistent baseline elevation (>11.4 ng/mL on repeat testing): Suggests underlying mast cell disorder, indolent systemic mastocytosis, or hereditary alpha-tryptasemia; warrants further diagnostic evaluation
- Normal baseline with acute elevation: Indicates isolated anaphylactic event without underlying mast cell disorder
- Serial measurements: Tryptase peaks at 15 minutes to 3 hours after anaphylaxis onset and returns to baseline within 24-48 hours; serial testing demonstrates this pattern
- Very high levels (>100 ng/mL): Suggests aggressive systemic mastocytosis or severe mast cell-mediated condition
- Factors affecting interpretation:
- Timing of sample collection: Earlier samples (within 3 hours of onset) more likely to detect acute elevation
- Biphasic anaphylaxis: Second rise in tryptase may occur hours after initial reaction
- Severity of reaction: More severe anaphylaxis produces higher tryptase elevations
- Patient race/ethnicity: Hereditary alpha-tryptasemia more common in certain populations and affects baseline levels
- Treatment administered: Epinephrine and antihistamines may affect peak tryptase timing
- Clinical significance: Tryptase is more specific for anaphylaxis than for mild allergic reactions; negative tryptase does not exclude allergy but suggests non-IgE-mediated reaction or testing outside acute window
- Associated Organs
- Primary organ systems involved:
- Immune system: Mast cells and basophils produce tryptase upon IgE-mediated activation
- Respiratory system: Affects airways, lungs; anaphylaxis may cause bronchospasm and laryngeal edema
- Cardiovascular system: Vascular permeability changes cause hypotension, shock; tryptase contributes to hemodynamic collapse
- Gastrointestinal system: May cause abdominal cramps, nausea, vomiting, diarrhea during anaphylaxis
- Integumentary system: Causes urticaria, angioedema, flushing
- Conditions commonly associated with elevated tryptase:
- Anaphylaxis: IgE-mediated reactions to food, drugs, insect venom, latex, or other triggers
- Systemic mastocytosis: Clonal disorder with excessive mast cell proliferation; can be indolent, smoldering, or aggressive
- Hereditary alpha-tryptasemia: Genetic condition with elevated baseline tryptase; may predispose to severe anaphylaxis
- Mast cell activation syndrome (MCAS): Condition with recurrent mast cell-mediated symptoms
- Urticaria and angioedema: Mast cell-mediated cutaneous reactions
- Scombroid reaction: Histamine-mediated reaction to spoiled fish
- Potential complications of elevated tryptase conditions:
- Life-threatening anaphylaxis: Severe reactions can cause death if untreated
- Biphasic reactions: Second wave of symptoms hours after initial anaphylaxis resolves
- Chronic effects of systemic mastocytosis: Bone disease, GI symptoms, malabsorption, organ infiltration
- Psychological impact: Recurrent anaphylaxis or chronic mast cell disease affects quality of life
- Malignant transformation: Rare but possible in systemic mastocytosis; can progress to mast cell leukemia
- Primary organ systems involved:
- Follow-up Tests
- Recommended based on elevated acute tryptase during anaphylaxis:
- Baseline tryptase: Repeat measurement 2-6 weeks after acute event when patient completely asymptomatic
- Allergen-specific IgE testing: Identify triggering allergen for food, drug, insect venom, or environmental allergies
- Total IgE: Assess overall immunoglobulin E levels; elevated in atopic individuals
- Skin prick testing: Confirm IgE-mediated allergy to specific allergens
- Recommended if baseline tryptase persistently elevated (>11.4 ng/mL):
- Bone marrow biopsy and aspirate: Evaluate for systemic mastocytosis; includes morphology, immunophenotype, genetic testing for KIT D816V mutation
- KIT mutation testing: Identify D816V mutation associated with systemic mastocytosis
- Alpha-tryptase gene testing: Assess for hereditary alpha-tryptasemia
- Metabolite testing: Measure 24-hour urine histamine and methylhistamine; serum chromogranin A; helpful in mast cell activation syndrome
- Imaging studies: Bone scan (DEXA), abdominal imaging to assess for organ involvement
- Complementary information tests:
- Histamine levels: Fresh blood collected in EDTA tube, kept cold; peaks during acute anaphylaxis
- Heparin levels: Elevated in some patients; can affect test results
- Tryptase component analysis: Differentiate alpha and beta tryptase subtypes
- Monitoring frequency:
- After initial anaphylaxis: Baseline sample at 2-6 weeks; no routine follow-up unless recurrent episodes
- With recurrent anaphylaxis: Evaluate for underlying mast cell disorder; repeat baseline tryptase
- With systemic mastocytosis: Annual monitoring or as clinically indicated; assess disease progression
- Recommended based on elevated acute tryptase during anaphylaxis:
- Fasting Required?
- Fasting requirement: No - fasting is NOT required for tryptase testing
- Blood sample can be collected regardless of meals or food intake
- Special patient preparation requirements:
- Timing critical for acute samples: Collect during acute symptoms or within 15 minutes to 3 hours after anaphylaxis onset for maximum diagnostic value
- Baseline samples: Patient should be symptom-free and relaxed; avoid collection immediately after stress or physical activity
- Sample handling: Blood must be drawn into appropriately prepared tubes (typically serum separator tube); use appropriate technique to minimize hemolysis
- Immediate processing: Sample should reach laboratory promptly; delays may affect accuracy
- Medications: No medications need to be avoided before tryptase testing; continue all routine medications unless directed otherwise
- Important note: For acute anaphylaxis samples, treatment with epinephrine should NOT be delayed to obtain blood draw; collect sample after emergency treatment established if possible
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