Diagnostic Value of Tryptase in Anaphylaxis and Mastocytosis

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Tryptase background

The principal protein component of human mast cell secretory granules was first detected as trypsin-like activity by histoenzymatic stains [1], [2], [3] and then as releasable trypsin-like activity [4]. The enzyme accounting for greater than 90% of this activity was named tryptase [5], [6], which was shown in vitro to be a marker of mast cell degranulation that was released in parallel with histamine and β-hexosaminidase.

Tryptase as a clinical marker of anaphylaxis and mastocytosis

Because tryptase is selectively and abundantly produced by mast cells, tryptase levels in biologic fluids should provide a more precise measure of local or systemic involvement of these cells than is possible to ascertain by clinical presentation or documentation of antigen-specific IgE. Basophils, the only other cell type that normally expresses tryptase, contain approximately 1/500th the amount [31]. Accordingly, mouse mAbs were prepared against human tryptase to develop specific tryptase

Summary

Serum (or plasma) levels of total and mature tryptase measurements are recommended in the diagnostic evaluation of systemic anaphylaxis and systemic mastocytosis, but their interpretation must be considered in the context of a complete workup of each patient. Total tryptase levels generally reflect the increased burden of mast cells in patients with all forms of systemic mastocytosis (indolent systemic mastocytosis, smoldering systemic mastocytosis, systemic mastocytosis associated with a

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    This work was supported by National Institutes of Health grant RO1 AI20487.

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