Hansen Karolina, Bjornsson Hjalti Mar, Gunnbjornsdottir Maria I
Faculty of Medicine, School of Health Sciences, University of Iceland.
Faculty of Medicine, School of Health Sciences, University of Iceland, Emergency department, National University Hospital, Reykjavik, Iceland.
Laeknabladid. 2021 Oct;107(10):470-475. doi: 10.17992/lbl.2021.10.656.
Background Diagnosing anaphylaxis is often straightforward but can be challenging if the presentation is atypical. In patients with atypical symptoms suspected to be due to an acute allergic reaction, s-tryptase can give additional diagnostic information. Measuring s-tryptase is also helpful in diagnosing mastocytosis. Obtaining s-tryptase levels has been done in the emergency department (ED) at Landspitali since 2011. The aim of this study was to evaluate the benefit of obtaining s-tryptase levels in the ED. Methods With institutional review board approval, all cases where s-tryptase level was obtained in ED patients from 2011-2018 were retrospectively reviewed. A database was collected including information on patient demographics, presenting symptoms, treatment, diagnosis, s-tryptase level and follow up. Results A total of 214 patients had a s-tryptase level measured. Serum tryptase was elevated (>12 μg/L) in 36 cases. Females were 131 and average age 40.6 years. Of the patients, 86.4% had skin or mucosal symptoms, 48.1% cardiovascular symptoms, 49.5% respiratory symptoms and 36.0% had gastrointestinal symptoms. An allergist reviewed 126 returning patients and 65 were considered to have had an episode of anaphylaxis. Of those 65 were 4 patients which did not meet the diagnostic criteria for anaphylaxis but had raised s-tryptase levels. Sensitivity of s-tryptase measurement was 40.9% and specificity 97.1%. Conclusions Obtaining a s-tryptase level from ED patients with possible anaphylaxis seems to be useful in atypical cases. The measurement is specific but not sensitive. No cases of mastocytosis were identified in the patient cohort.
诊断过敏反应通常很直接，但如果表现不典型则可能具有挑战性。对于疑似急性过敏反应的非典型症状患者，可溶性组织蛋白酶（s-tryptase）可提供额外的诊断信息。检测s-tryptase对肥大细胞增多症的诊断也有帮助。自2011年以来，冰岛国家大学医院急诊科（ED）一直在检测s-tryptase水平。本研究的目的是评估在急诊科检测s-tryptase水平的益处。方法：经机构审查委员会批准，对2011年至2018年在急诊科患者中检测s-tryptase水平的所有病例进行回顾性分析。收集了一个数据库，包括患者人口统计学信息、症状表现、治疗、诊断、s-tryptase水平及随访情况。结果：共有214例患者检测了s-tryptase水平。36例患者血清组织蛋白酶升高（>12μg/L）。女性131例，平均年龄40.6岁。患者中，86.4%有皮肤或黏膜症状，48.1%有心血管症状，49.5%有呼吸道症状，36.0%有胃肠道症状。一名过敏症专科医生对126例复诊患者进行了评估，其中65例被认为发生过过敏反应。在这65例患者中，有4例不符合过敏反应的诊断标准，但s-tryptase水平升高。s-tryptase检测的敏感性为40.9%，特异性为97.1%。结论：对可能发生过敏反应的急诊科患者检测s-tryptase水平在非典型病例中似乎有用。该检测具有特异性，但不敏感。在该患者队列中未发现肥大细胞增多症病例。
