PMID- 29189281
OWN - NLM
STAT- MEDLINE
DCOM- 20190816
LR  - 20190816
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 127
IP  - 2
DP  - 2018 Aug
TI  - Improvement of the Elevated Tryptase Criterion to Discriminate IgE- From 
      Non-IgE-Mediated Allergic Reactions.
PG  - 414-419
LID - 10.1213/ANE.0000000000002656 [doi]
AB  - BACKGROUND: Differentiating between immunoglobulin E (IgE)-dependent and 
      IgE-independent hypersensitivity reactions may improve the etiologic orientation 
      and clinical management of patients with allergic reactions in the anesthesia 
      setting. Serum tryptase levels may be useful to discriminate the immune mechanism 
      of allergic reactions, but the diagnostic accuracy and optimal cutpoint remain 
      unclear.We aimed to compare the diagnostic accuracy of tryptase during reaction 
      (TDR) alone and the TDR/basal tryptase (TDR/BT) ratio for discriminating IgE- 
      from non-IgE-mediated allergic reactions, and to estimate the best cut point for 
      these indicators. METHODS: We included 111 patients (45% men; aged 3-99 years) 
      who had experienced an allergic reaction, even though the allergic reaction could 
      be nonanaphylactic. Allergy tests were performed to classify the reaction as an 
      IgE- or non-IgE-mediated one. The area under the curve (AUC) of the receiver 
      operating characteristic analysis was performed to estimate the discriminative 
      ability of TDR and TDR/BT ratio. RESULTS: An IgE-mediated reaction was diagnosed 
      in 49.5% of patients, and 56% of patients met anaphylaxis criteria. The median 
      (quartiles) TDR for the IgE-mediated reactions was 8.0 (4.9-19.6) and 5.1 
      (3.5-8.1) for the non-IgE-mediated (P = .022). The median (quartiles) TDR/BT 
      ratio was 2.7 (1.7-4.5) in IgE-mediated and 1.1 (1.0-1.6) in non-IgE-mediated 
      reactions (P < .001). The TDR/BT ratio showed the greatest ability to 
      discriminate IgE- from non-IgE-mediated reactions compared to TDR (AUC TDR/BT = 
      0.79 [95% confidence interval (CI), 0.70-0.88] and AUC TDR = 0.66 [95% CI, 
      0.56-0.76]; P = .001). The optimal cut point for TDR/BT (maximization of the sum 
      of the sensitivity and specificity) was 1.66 (95% CI, 1.1-2.2). CONCLUSIONS: The 
      TDR/BT ratio showed a significantly better discriminative ability than TDR to 
      discriminate IgE- from non-IgE-mediated allergic reactions. An optimal TDR/BT 
      ratio threshold of approximately 1.66 may be useful in clinical practice to 
      classify allergic reactions as IgE- or non-IgE-mediated.
FAU - Gastaminza, Gabriel
AU  - Gastaminza G
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - Lafuente, Alberto
AU  - Lafuente A
AD  - Anaesthesia.
FAU - Goikoetxea, Maria Jose
AU  - Goikoetxea MJ
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - D'Amelio, Carmen M
AU  - D'Amelio CM
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - Bernad-Alonso, Amalia
AU  - Bernad-Alonso A
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - Vega, Olga
AU  - Vega O
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - Martinez-Molina, Juan Ambrosio
AU  - Martinez-Molina JA
AD  - Anaesthesia.
FAU - Ferrer, Marta
AU  - Ferrer M
AD  - From the Departments of Allergology and Clinical Immunology.
FAU - Nunez-Cordoba, Jorge M
AU  - Nunez-Cordoba JM
AD  - Research Support Service, Central Clinical Trials Unit, Clinica Universidad de 
      Navarra, Pamplona, Spain.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Receptors, IgE)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - EC 3.4.21.59 (Tryptases)
EIN - Anesth Analg. 2018 Nov;127(5):e94. PMID: 30335659
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthesia/adverse effects
MH  - Area Under Curve
MH  - Child
MH  - Child, Preschool
MH  - Drug Hypersensitivity/blood
MH  - Female
MH  - Humans
MH  - Hypersensitivity/blood/*immunology
MH  - Immunoglobulin E/blood
MH  - Male
MH  - Middle Aged
MH  - Receptors, IgE/blood
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Skin Tests
MH  - Tryptases/*analysis
MH  - Young Adult
EDAT- 2017/12/01 06:00
MHDA- 2019/08/17 06:00
CRDT- 2017/12/01 06:00
PHST- 2017/12/01 06:00 [pubmed]
PHST- 2019/08/17 06:00 [medline]
PHST- 2017/12/01 06:00 [entrez]
AID - 10.1213/ANE.0000000000002656 [doi]
PST - ppublish
SO  - Anesth Analg. 2018 Aug;127(2):414-419. doi: 10.1213/ANE.0000000000002656.