Curtin University Homepage
  • Library
  • Help
    • Admin

    espace - Curtin’s institutional repository

    JavaScript is disabled for your browser. Some features of this site may not work without it.
    View Item 
    • espace Home
    • espace
    • Curtin Research Publications
    • View Item
    • espace Home
    • espace
    • Curtin Research Publications
    • View Item

    Serum mast cell tryptase measurements: Sensitivity and specificity for a diagnosis of anaphylaxis in emergency department patients with shock or hypoxaemia

    Access Status
    Fulltext not available
    Authors
    Francis, A.
    Fatovich, Daniel
    Arendts, Glenn
    Macdonald, S.
    Bosio, E.
    Nagree, Y.
    Mitenko, H.
    Brown, S.
    Date
    2018
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Francis, A. and Fatovich, D. and Arendts, G. and Macdonald, S. and Bosio, E. and Nagree, Y. and Mitenko, H. et al. 2018. Serum mast cell tryptase measurements: Sensitivity and specificity for a diagnosis of anaphylaxis in emergency department patients with shock or hypoxaemia. EMA - Emergency Medicine Australasia. 30 (3): pp. 366-374.
    Source Title
    EMA - Emergency Medicine Australasia
    DOI
    10.1111/1742-6723.12875
    ISSN
    1742-6731
    School
    School of Nursing, Midwifery and Paramedicine
    URI
    http://hdl.handle.net/20.500.11937/71773
    Collection
    • Curtin Research Publications
    Abstract

    © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Objective: Clinical diagnosis of anaphylaxis is principally based on symptoms and signs. However, particularly for patients with atypical symptoms, laboratory confirmation of anaphylaxis would be useful. This study investigated the utility of mast cell tryptase, an available clinical biomarker, for differentiating anaphylaxis from other causes of critical illness, which can also involve mast cell activation. Methods: Tryptase was measured (ImmunoCAP) in serum from patients with anaphylaxis and non-anaphylactic critical illness (controls) at ED arrival, and after 1–2, 3–4 and 12–24 h. Differences in both peak and delta (difference between highest and lowest) tryptase concentrations between groups were investigated using linear regression models, and diagnostic ability was analysed using Receiver Operating Characteristic curve analysis. Results: Peak tryptase was fourfold (95% CI: 2.9, 5.5) higher in anaphylaxis patients (n = 67) than controls (n = 120) (P < 0.001). Delta-tryptase was 5.1-fold (95% CI: 2.9, 8.9) higher in anaphylaxis than controls (P < 0.001). Optimal test characteristics (sensitivity: 72% [95% CI: 59, 82] and specificity: 72% [95%CI: 63, 80]) were observed when peak tryptase concentrations were >11.4 ng/mL and/or delta-tryptase =2.0 ng/mL. For hypotensive patients, peak tryptase >11.4 ng/mL had improved test characteristics (sensitivity: 85% [95% CI: 65, 96] and specificity: 92% [95% CI: 85, 97]); the use of delta-tryptase reduced test specificity. Conclusion: While peak and delta tryptase concentrations were higher in anaphylaxis than other forms of critical illness, the test lacks sufficient sensitivity and specificity. Therefore, mast cell tryptase values alone cannot be used to establish the diagnosis of anaphylaxis in the ED. In particular, tryptase has limited utility for differentiating anaphylactic from non-anaphylactic shock.

    Related items

    Showing items related by title, author, creator and subject.

    • Immunological profiles of immune restoration disease presenting as mycobacterial lymphadenitis and cryptococcal meningitis
      Tan, D.; Yong, Y.; Tan, H.; Kamarulzaman, A.; Tan, L.; Lim, A.; James, I.; French, M.; Price, Patricia (2008)
      Objectives: A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy ...
    • Low back related leg pain: development and preliminary validation of a new classification system
      Schäfer, Axel (2009)
      Background summary. Leg pain is a common complaint in relation to low back pain (LBP), present in up to 65% of all patients with LBP. Radiating leg pain is an important predictor for chronicity of LBP and an indicator of ...
    • Novel strategies for inhibiting cancer growth
      Schaefer, Rainer (2008)
      At present, most cancers are treated with surgery, radiotherapy and chemotherapy, used alone or in combination. Surgery and radiotherapy are the primary treatment modalities after early detection of cancers and they ...
    Advanced search

    Browse

    Communities & CollectionsIssue DateAuthorTitleSubjectDocument TypeThis CollectionIssue DateAuthorTitleSubjectDocument Type

    My Account

    Admin

    Statistics

    Most Popular ItemsStatistics by CountryMost Popular Authors

    Follow Curtin

    • 
    • 
    • 
    • 
    • 

    CRICOS Provider Code: 00301JABN: 99 143 842 569TEQSA: PRV12158

    Copyright | Disclaimer | Privacy statement | Accessibility

    Curtin would like to pay respect to the Aboriginal and Torres Strait Islander members of our community by acknowledging the traditional owners of the land on which the Perth campus is located, the Whadjuk people of the Nyungar Nation; and on our Kalgoorlie campus, the Wongutha people of the North-Eastern Goldfields.