Univ Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier.
University Hospital of Nîmes, Immunology Laboratory, Nîmes.
Curr Opin Allergy Clin Immunol. 2024 Oct 1;24(5):293-299. doi: 10.1097/ACI.0000000000001012. Epub 2024 Jul 24.
The purpose of this narrative review was to summarize data and official recommendations purporting to paired tryptase determination in patients experiencing drug-induced anaphylaxis, published between January 1, 2023 and June 1, 2024.
Three main lines of evidence obtained through paired acute and baseline tryptase determination were identified: diagnostic criterion for hypersensitivity reactions involving systemic mast cell activation; differential diagnostic criterion for hypersensitivity reactions involving other mechanisms of immediate reactions; and added value of acute and baseline tryptase levels for personalized management following drug-induced anaphylaxis: cause, risk of recurrence, underlying mast cell conditions including hereditary α-tryptasemia, familial clusters.
The implementation of existing guidelines which consensually recommend paired tryptase measurement is a persistent unmet need hampering optimal diagnosis of drug-induced anaphylaxis and patient management. Another major unmet need is the lack of standardized recommendations for hereditary α-tryptasemia testing and counselling. Progress in this field is seen at a rapid pace, requiring significant efforts of continued medical education for practicing clinicians and laboratory specialists worldwide.
本文旨在总结 2023 年 1 月 1 日至 2024 年 6 月 1 日期间发表的关于药物诱发过敏反应中配对胰蛋白酶测定的数据和官方建议。
通过配对的急性和基础胰蛋白酶测定获得了三条主要证据线：涉及全身性肥大细胞激活的过敏反应的诊断标准；涉及其他即刻反应机制的过敏反应的鉴别诊断标准；以及急性和基础胰蛋白酶水平对药物诱发过敏反应后个体化管理的附加价值：病因、复发风险、包括遗传性 α-胰蛋白酶血症在内的潜在肥大细胞疾病、家族聚集性。
现有指南一致建议进行配对胰蛋白酶测定，但执行情况不佳，这仍然是药物诱发过敏反应的诊断和患者管理方面未满足的需求。另一个主要的未满足需求是缺乏遗传性 α-胰蛋白酶血症检测和咨询的标准化建议。该领域的进展迅速，需要全球临床医生和实验室专家进行持续医学教育方面的大量投入。
