Tryptase Levels as an Indicator of Mast-Cell Activation in Systemic Anaphylaxis and Mastocytosis

Authors

Lawrence B. Schwartz , M.D., Ph.D., Virginia Commonwealth UniversityFollow
Dean D. Metcalfe , M.D., National Institutes of Health
Jeffrey S. Miller , M.D., University of Minnesota
Harry Earl , M.D., University of Texas Health Science Center at Dallas
Timothy Sullivan , M.D., University of Texas Health Science Center at Dallas

Document Type

Article

Original Publication Date

1987

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

316

Issue

26

First Page

1622

Last Page

1626

DOI of Original Publication

10.1056/NEJM198706253162603

Comments

Originally published at http://dx.doi.org/10.1056/NEJM198706253162603

Date of Submission

January 2015

Abstract

Abstract

Better methods are needed to assess mastcell activation In vivo and to distinguish the activation of mast cells from that of basophils. Tryptase, a neutral protease selectively concentrated in the secretory granules of human mast cells (but not basophils), is released by mast cells together with histamine and serves as a marker of mast-cell activation.

In 17 patients with systemic mastocytosis, concentrations of tryptase in plasma were linearly related to those of histamine (P<0.01). Eleven of the 17 patients had tryptase levels of 4 to 88 ng per milliliter, indicating ongoing mast-cell activation. In each of six patients who experienced corresponding anaphylactic reactions after penicillin, aspirin, or melon ingestion, a wasp sting, exercise, or antilymphocyte globulin injection, tryptase levels in serum ranged from 9 to 75 ng per milliliter, indicating mast-cell activation during each of these events. In contrast, serum tryptase levels were less than 5 ng per milliliter in all patients presenting with myocardial disease (n = 8, 6 with hypotension) or sepsis (n = 6, 3 with hypotension) and in the controls (n = 20). One patient had a myocardial infarction after anaphylaxis in response to a wasp sting and an elevated tryptase level of 25 ng per milliliter. Thus, the plasma or serum tryptase level is a diagnostic correlate of mast-cell-related events. (N Engl J Med 1987; 316: 1622–6.)

Rights

From The New England Journal of Medicine, Schwartz, L.B., Metcalfe, D.D., Miller, J.S., et al., Tryptase Levels as an Indicator of Mast-Cell Activation in Systemic Anaphylaxis and Mastocytosis, Vol. 316, Page 1622, Copyright © 1987 Massachusetts Medical Society. Reprinted with permission.

Is Part Of

VCU Internal Medicine Publications