Clinic of Allergology and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2024 Aug 23;60(9):1380. doi: 10.3390/medicina60091380.
Tryptase is an important biomarker widely used in the laboratory confirmation of severe hypersensitivity reactions, especially anaphylaxis. It also plays a crucial role in the diagnosis, risk stratification, management and prognostic evaluation of many other mast cell-related conditions. This paper aims to highlight the role of serum tryptase, both in allergic disorders and other mast cell-related conditions. Two clinical cases regarding timely serum tryptase acquisition (in drug hypersensitivity reactions during the imaging procedure and perioperative anaphylaxis) are meant to emphasize the clinical potential of this protease. We performed a comprehensive literature search of the PubMed/Medline and Scopus databases. From a total of 640 subject related publications, dating from 1940 to 2024, 45 articles written in English were selected. Total serum tryptase is a simple, cost-effective analysis with a normal baseline tryptase (sBT) level below 8.4 µg/L. Elevated sBT can indicate hereditary alpha-tryptasemia (HαT), mastocytosis and other non-allergic disorders. Patients with higher sBT levels, especially with insect venom allergy, have an increased risk of severe reactions and thereby require a prolonged treatment. All immediate systemic hypersensitivity reactions require a correlation between serum acute tryptase (sAT) and sBT. According to the guidelines, measuring sAT 30 min to 2 h after the symptom onset and sBT 24 h after the resolution, using the 20 + 2 rule and an sAT/sBT ratio of 1.685, improves the diagnostic accuracy in anaphylaxis. Tryptase levels should be acquired in all cases with clinical suspicion of MC degranulation. Given the increasing clinical relevance, elevated baseline serum tryptase levels require a multidisciplinary approach and further investigation.
类胰蛋白酶是一种广泛用于严重过敏反应（尤其是过敏反应）的实验室确认的重要生物标志物。它在许多其他肥大细胞相关疾病的诊断、风险分层、管理和预后评估中也起着至关重要的作用。本文旨在强调血清类胰蛋白酶在过敏症和其他肥大细胞相关疾病中的作用。通过两个关于及时获取血清类胰蛋白酶（药物过敏反应期间的影像学检查和围手术期过敏反应）的临床病例，强调了这种蛋白酶的临床潜力。我们对 PubMed/Medline 和 Scopus 数据库进行了全面的文献检索。从总共 640 篇与主题相关的出版物中，我们选择了 45 篇 1940 年至 2024 年期间用英文撰写的文章。总血清类胰蛋白酶是一种简单、具有成本效益的分析方法，正常基线类胰蛋白酶（sBT）水平低于 8.4µg/L。升高的 sBT 可能表明遗传性α-类胰蛋白酶血症（HαT）、肥大细胞增多症和其他非过敏疾病。sBT 水平较高的患者，特别是患有昆虫毒液过敏的患者，严重反应的风险增加，因此需要延长治疗时间。所有立即发生的全身性过敏反应都需要血清急性类胰蛋白酶（sAT）与 sBT 之间的相关性。根据指南，在症状发作后 30 分钟至 2 小时测量 sAT，并在症状缓解后 24 小时测量 sBT，使用 20+2 规则和 1.685 的 sAT/sBT 比值，可提高过敏反应的诊断准确性。应在所有临床怀疑肥大细胞脱颗粒的病例中获取类胰蛋白酶水平。鉴于其临床相关性不断增加，基线血清类胰蛋白酶水平升高需要采取多学科方法并进行进一步调查。
