Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.4)
Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2012, vol. 21, nr 3, May-June, p. 403–408

Publication type: review article

Language: English

Tryptase in Diagnosing Adverse Suspected Anaphylactic Reaction

Tryptaza w diagnostyce reakcji niepożądanych podejrzanych o anafilaksję podczas znieczulenia oraz w okresie okołooperacyjnym

Grażyna Michalska-Krzanowska1,

1 Division of Anesthesiology and Intensive Care, 111th Military Hospital with Outpatient Clinic Poznań, Poland

Abstract

Determination of serum mast cell tryptase (MCT) is becoming more widely used in diagnosing allergic reactions involving mast cells. It can help evaluate the allergenic effects of drugs administered during anesthesia and the perioperative period. Until now, data about the role of tryptase in the body has not been clarified yet. Patients with elevated MCT levels should undergo further testing to find out the causative agent of a potential allergic reaction. Patients with normal tryptase concentration should also undergo further diagnosis if they manifest clinical symptoms of a severe anaphylactic reaction.

Streszczenie

Oznaczenie stężenia tryptazy (Mast Cell Tryptase – MCT) w surowicy krwi znajduje coraz szersze zastosowanie w diagnostyce reakcji alergicznych z udziałem komórki tucznej. Może być wykorzystywane w celu oceny alergizującego działania leków podawanych podczas znieczulenia oraz w okresie okołooperacyjnym. Dotychczas rola tryptazy w organizmie nie została ostateczne określona. Pacjenci ze zwiększonym stężeniem MCT powinni być poddawani dalszym badaniom w celu poszukiwania środka sprawczego, potencjalnej reakcji alergicznej. Pacjenci z prawidłowym stężeniem tryptazy także powinni być poddawani dalszej diagnostyce, jeżeli mają kliniczne objawy ciężkiej reakcji anafilaktycznej.

Key words

tryptase, anaphylaxis, anesthesia, perioperative period

Słowa kluczowe

tryptaza, anafilaksja, znieczulenie, okres okołooperacyjny

References (26)

  1. Hepner DL, Castells M: Anaphylaxis during the perioperative period. Anest Analg 2003, 97, 1381–1395.
  2. Mertes PM, Laxenaire MC: Anaphylaxis during general anaesthesia – prevention and management. CNS Drugs 2000, 14, 115–133.
  3. Guttormsen AB: Allergic reactions during anaesthesia – increased attention to the problem in Denmark and Norway. Acta Anaesthesiol Scand 2001, 45, 1189–1190.
  4. Kroigaard M, Garvey LH, Gillberg L, Johansson SG: Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand 2007, 51, 655–670.
  5. Harboe T, Guttormsen AB, Dybendal T: Anaphylaxis during anesthesia in Norway. Anesthesiology 2005, 102, 897–903.
  6. Krishnaswamy G, Kelley J, Johanson D: The human mast cell: functions in physiology and disease. Frontiers Biosci 2001, 6, 1109–1127.
  7. Gell PG, Coombs RA, Lachmann PF: Clinical aspects of immunology. In: Atopy. Ed.: Pepys J. Oxford, Blackwell Scientific. Ed 3 1975, 877–902.
  8. Metcalfe DD, Baram D, Mekori YA: Mastcells. Physiol Rev 1997, 77, 1033–1079.
  9. Galli SJ, Nakae S, Tsai M: Mast cell in the development of adaptive immune responses. Nat Immunol 2005, 6, 135–142.
  10. He S, Xie H: Modulation of tryptase release from human tonsil mast cells by protease inhibitors. Pharmacol Rep 2005, 57, 523–530.
  11. Payne V, Kam PCA: Mast cell tryptase: a review of its physiology and clinical significance. Anaesthesia 2004, 59, 695–703.
  12. Marone G: Human basophils and mast cells. Biological aspects. Dvorak AM ultrastructural analysis of human mast cells and basophils. Chem Immunol 1995, 61, 1–28.
  13. Marone G: Human basophils and mast cells: Biological Aspects. MacGlashan DW – Signal transduction and cytokine production by human basophils. Chem Immunol Basel Karger 1995, 61, 88–113.
  14. Pereira PJ, Bergner A, Macedo-Ribeiro S, Hubner R: Human beta-tryptase is a ring-like tetramer with active sites facing a central pore. Nature 1998, 392, 306–311.
  15. Hallgren J, Spillmann D, Pejler G: Structural requirements and mechanism for heparin-induced activation of a recombinant mouse mast cell tryptase, mouse mast cell protease-6: formation of active tryptase monomers in the presence of low molecular weight heparin. J Biol Chem 2001, 276, 42774–42781.
  16. He SH, Xie H, He YS: Induction of tryptase and histamine release from human colon mast cells by IgE dependent or independent mechanisms. World J Gastroenterol 2004, 10, 319–322.
  17. Veien M, Szlam F, Holden J, Levy J: Mechanism of nonimmunological histamine and tryptase release from human cutaneous mast cells. Anesthesiology 2000, 92, 1074–1081.
  18. Stellato C, Paulis A, Cirillo R: Heterogeneity of human mast cells and basophils in response to muscle relaxants. Anaesthesiology 1991, 74, 1078–1086.
  19. Enrique E, Garcia-Ortega P, Sotorra O: Usefulness of UniCAP tryptase fluoroimmunoassay in the diagnosis of anaphylaxis. Allergy 1999, 54, 602–606.
  20. Schwartz LB, Yunginger JW, Miller J: Time course of appearance and disappearance of human mast cell tryptase in the circulation after anaphylaxis. J Clin Invest 1989, 83, 1551–1555.
  21. The Association of Anaesthetists of Great Britain and Ireland: Suspected anaphylactic reactions associated with anaesthesia, August 2003.
  22. Lange M, Renke J, Gleń J: Tryptasa mastocytowa, interleukina 6 jako wykładnik ciężkości przebiegu mastocytozy. Post Dermatol Alergoz 2010, 27, 4, 238–245.
  23. Austin FK: Allergies, Anaphylaxis and systemic mastocytosis. In: Harrisons Principles of International Medicine. Eds.: Braunwald E, Fauce AS, Kasper DL, 15th ed. New York: McGraw-Hill 2001, 1919–1920.
  24. Koppert W, Blunk J, Petersen L: Different patterns of mast cell activation by muscle relaxants in human skin. Anaesthesiology 2001, 95, 659–667.
  25. Yunginger JW, Nelson DR: Laboratory investigation of deaths due to anaphylaxis. J Forensic Sci 1991, 36, 857– 865.
  26. Hallgren J, Pejler G: Biology of mast cell tryptase. FEBS J 2006, 273, 1871–1895.