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Validation of international consensus equation for acute serum total tryptase in mast cell activation: A perioperative perspective
Author(s) -
Baretto R. L.,
Beck S.,
Heslegrave J.,
Melchior C.,
Mohamed O.,
Ekbote A.,
Huissoon A. P.,
Krishna M. T.
Publication year - 2017
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13226
Subject(s) - anaphylaxis , medicine , tryptase , interquartile range , immunoglobulin e , perioperative , receiver operating characteristic , allergy , mast cell , gastroenterology , anesthesia , immunology , antibody
There is no standardized method for assessing serum total mast cell tryptase ( MCT ) in anaphylaxis. The consensus equation (peak MCT should be>1.2× baseline tryptase+2 mg/L) has been proposed to interpret acute MCT in mast cell activation syndrome ( MCAS ). To validate consensus equation in a perioperative setting analyses of cases of suspected perioperative anaphylaxis during general anaesthesia ( GA ) were performed. Anaphylaxis was defined as per World Allergy Organisation ( WAO ) criteria. Timed serial MCT measurements were mapped against the consensus equation and receiver operating characteristic ( ROC ) curves produced. A total of 82 patients (60 females, mean age 56.5 years± SD 17.2) underwent investigation. Sixty (73%) patients fulfilled WAO criteria for anaphylaxis, and 22 patients did not. Aetiology included 59% IgE‐mediated anaphylaxis, 2% non‐IgE‐mediated anaphylaxis, 12% anaphylaxis of unknown cause and 27% deemed non‐anaphylaxis. IgE‐mediated anaphylaxis included the following: NMBA (35%), antibiotics (46%), chlorhexidine (8%), patent blue dye (8%) and others (8%). An acute MCT with a comparable baseline was available in 71 of 82 (87%) patients (60 anaphylaxis and 11 controls). The median interquartile range ( IQR ) time from reaction to peak MCT was 1.34 (0.82‐2.51) hours. Analyses confirmed that a rise in acute MCT greater than that defined by the equation had a sensitivity, specificity, positive predictive value ( PPV ) and negative (N) PV of 78%, 91%, 98% and 44%, respectively. The magnitude of increase in acute MCT above the threshold predicted by consensus equation was higher in the anaphylaxis group compared to controls ( P =.0001). This equation has a high specificity, PPV with a moderate NPV and sensitivity in perioperative anaphylaxis.