Mak Hugo W F, Au Elaine Y L, Yeung Maegan H Y, Chiang Valerie, Lam Ki, Wong Jane C Y, Yeung Heather H F, Chan Eric Y T, Lau Chak-Sing, Li Philip H
Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong.
Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
J Allergy Clin Immunol Glob. 2024 Jul 3;3(4):100297. doi: 10.1016/j.jacig.2024.100297. eCollection 2024 Nov.
Basophil activation tests (BATs) are useful in identifying culprits of perioperative anaphylaxis (PA), but their utility remains limited due to technical limitations, cost, and availability. Being able to prioritize patients with likely higher yields for BAT would be useful in reducing costs and manpower.
We sought to investigate whether tryptase levels and clinical parameters may be useful for selecting patients for BATs.
We performed a 10-year retrospective study in Hong Kong to investigate the performance of BATs associated with tryptase levels (taking during PA) and other clinical parameters.
Of 90 patients, 70 (77.8%) showed significant tryptase level elevation and 37 (41.1%) had a positive BAT result. BAT-positive patients presented with significantly higher absolute levels (15.9 μg/L vs 9.1 μg/L; = .018), absolute elevation (12.8 μg/L vs 7.1 μg/L; = .012), and fold elevation (5.6- vs 4.1-fold; = .014) of acute tryptase than did BAT-negative patients. Among patients with positive BAT result, 94.6% (35 of 37) demonstrated elevated acute tryptase, significantly more than the BAT-negative group (66.0%; < .001). In regression analysis, tryptase elevation was the sole significant factor correlated to BAT positivity (odds ratio, 10.14; 95% CI, 2.15-47.85; = .003). Overall, elevated acute tryptase demonstrated a sensitivity of 94.7% and a negative predictive value of 90.0% in predicting positive results with BATs.
We observed that tryptase elevation is a very sensitive predictor of BAT positivity among patients with identified culprits of PA. Acute elevation of tryptase would not only aid in confirming anaphylaxis but may also help guide the decision toward selecting labor-intensive and costly tests such as BATs.
嗜碱性粒细胞活化试验（BATs）有助于识别围手术期过敏反应（PA）的诱因，但由于技术限制、成本和可用性等因素，其应用仍然有限。能够对BATs可能有更高阳性率的患者进行优先排序，将有助于降低成本和人力。
我们试图研究类胰蛋白酶水平和临床参数是否有助于选择进行BATs检测的患者。
我们在香港进行了一项为期10年的回顾性研究，以调查与类胰蛋白酶水平（PA发作时测定）和其他临床参数相关的BATs的性能。
90例患者中，70例（77.8%）类胰蛋白酶水平显著升高，37例（41.1%）BAT结果为阳性。BAT阳性患者的急性类胰蛋白酶绝对水平（15.9μg/L对9.1μg/L；P = 0.018）、绝对升高值（12.8μg/L对7.1μg/L；P = 0.012）和升高倍数（5.6倍对4.1倍；P = 0.014）均显著高于BAT阴性患者。在BAT结果为阳性的患者中，94.6%（37例中的35例）急性类胰蛋白酶升高，显著高于BAT阴性组（66.0%；P < 0.??1）。在回归分析中，类胰蛋白酶升高是与BAT阳性相关的唯一显著因素（比值比，10.14；95%置信区间，2.15 - 47.85；P = 0.003）。总体而言，急性类胰蛋白酶升高在预测BAT阳性结果时的敏感性为94.7%，阴性预测值为90.0%。
我们观察到，在已确定PA诱因的患者中，类胰蛋白酶升高是BAT阳性的非常敏感的预测指标。急性类胰蛋白酶升高不仅有助于确诊过敏反应，还可能有助于指导选择如BATs等劳动密集型和昂贵检测的决策。
