Causes and Diagnostic Usefulness of Tryptase Measurements for Anaphylaxis in a Korean Tertiary Care General Hospital
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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.
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 (32)
- Simons FE, "Anaphylaxis pathogenesis and treatment", Allergy, 66(Suppl 95), pp.31~34 (2011)
- Yu JE, "The epidemiology of anaphylaxis", Clin Rev Allergy Immunol, 54, pp.366~374 (2018)
- Jerschow E, "Fatal anaphylaxis in the United States, 1999-2010 : temporal patterns and demographic associations", J Allergy Clin Immunol, 134, pp.1318~1328.e7 (2014)
- Waterfield T, "How to interpret mast cell tests", Arch Dis Child Educ Pract Ed, 101, pp.246~251 (2016)
- Vitte J, "Human mast cell tryptase in biology and medicine", Mol Immunol, 63, pp.18~24 (2015)
- Schwartz LB, "Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis", N Engl J Med, 316, pp.1622~1626 (1987)
- Cardona V, "World Allergy Organization anaphylaxis guidance 2020", World Allergy Organ J, 13, pp.100472~ (2020)
- [URL]
- Valent P, "Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes : a consensus proposal", Int Arch Allergy Immunol, 157, pp.215~225 (2012)
- Stone SF, "Elevated serum cytokines during human anaphylaxis : identification of potential mediators of acute allergic reactions", J Allergy Clin Immunol, 124, pp.786~792.e4 (2009)
- Vitte J, "Paired acute-baseline serum tryptase levels in perioperative anaphylaxis : an observational study", Allergy, 74, pp.1157~1165 (2019)
- Muraro A, "EAACI guidelines : anaphylaxis(2021 update)", Allergy, 77, pp.357~377 (2022)
- Ring J, "Incidence and severity of anaphylactoid reactions to colloid volume substitutes", Lancet, 1, pp.466~469 (1977)
- Simons FE, "World Allergy Organization anaphylaxis guidelines : 2013 update of the evidence base", Int Arch Allergy Immunol, 162, pp.193~204 (2013)
- Wood RA, "Anaphylaxis in America : the prevalence and characteristics of anaphylaxis in the United States", J Allergy Clin Immunol, 133, pp.461~467 (2014)
- Cho H, "Common causes of emergency department visits for anaphylaxis in Korean community hospitals : a cross-sectional study", Medicine(Baltimore), 98, pp.e14114~ (2019)
- Lieberman PL, "Idiopathic anaphylaxis", Allergy Asthma Proc, 35, pp.17~23 (2014)
- Brereton A, "Anaphylaxis to muscle relaxants : an audit of ten years of allergy testing at the Royal Adelaide Hospital", Anaesth Intensive Care, 40, pp.861~866 (2012)
- 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", Expert Opin Drug Saf, 13, pp.15~23 (2014)
- Castells MC, "Anaphylaxis to chemotherapy and monoclonal antibodies", Immunol Allergy Clin North Am, 35, pp.335~348 (2015)
- Sim DW, "Clinical characteristics of adverse events associated with therapeutic monoclonal antibodies in Korea", Pharmacoepidemiol Drug Saf, 25, pp.1279~1286 (2016)
- 박경희, "Eperisone-Induced Anaphylaxis: Pharmacovigilance Data and Results of Allergy Testing", Allergy, Asthma & Immunology Research, 11(2), pp.231~240 (2019), 대한천식알레르기학회
- 예영민, "Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study", Allergy, Asthma & Immunology Research, 7(1), pp.22~29 (2015), 대한천식알레르기학회
- Jeong K, "A multicenter anaphylaxis registry in Korea : clinical characteristics and acute treatment details from infants to older adults", World Allergy Organ J, 13, pp.100449~ (2020)
- Ewan PW, "BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia", Clin Exp Allergy, 40, pp.15~31 (2010)
- Sheldon J, "Laboratory investigation of anaphylaxis : not as easy as it seems", Anaesthesia, 70, pp.1~5 (2015)
- Sala-Cunill A, "Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients", Int Arch Allergy Immunol, 160, pp.192~199 (2013)
- Cahill KN, "Plasma tryptase elevation during aspirin-induced reactions in aspirinexacerbated respiratory disease", J Allergy Clin Immunol, 143, pp.799~803.e2 (2019)
- 이지호, "A Case of Levofloxacin-Induced Anaphylaxis With Elevated Serum Tryptase Levels", Allergy, Asthma & Immunology Research, 5(2), pp.113~115 (2013), 대한천식알레르기학회
- Brockow K, "Detection of drug-specific immunoglobulin E(IgE)and acute mediator release for the diagnosis of immediate drug hypersensitivity reactions", J Immunol Methods, 496, pp.113101~ (2021)
- Komericki P, "Tryptase as severity marker in drug provocation tests", Int Arch Allergy Immunol, 140, pp.164~169 (2006)
- 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", Clin Exp Allergy, 48, pp.846~861 (2018)