The diagnosis of anaphylaxis relies on a suggestive clinical history after exposure to a potential triggering factor. Serum tryptase concentrations increase on degranulation of mast cells and therefore serum tryptase levels are measured to diagnose anaphylaxis. There is no standardized method for assessing total serum mast cell tryptase (MCT) in anaphylaxis. The Working Conference in 2010 proposed a consensus equation (peak MCT should be > 1.2x baseline tryptase + 2 ng/L) to diagnose acute mast cell activation (aMCA). Our objective was to narratively review the literature since the Working Conference in 2010, examining the use of the consensus equation and other equations comparing baseline and peak serum tryptase during anaphylaxis. Computerized bibliographic searches of PUBMED and EMBASE were supplemented with a manual search of reference lists. English-language studies were included. Eleven studies met our inclusion criteria with a total of 4551 participants. However, only four studies with 653 participants used the consensus equation. The other seven studies used other methods to compare peak and baseline serum tryptase concentrations. Measuring serum tryptase levels is valuable in the diagnosis of anaphylaxis but is unable to detect all anaphylactic reactions. Based on our current literature review, the consensus equation is underused in the diagnosis of anaphylaxis. There is also a need for exploration of other biomarkers which could be used in parallel to peak and baseline serum tryptase measurements for further diagnostic certainty. Serum tryptase is the most studied biomarker in anaphylaxis but is still far from being the ideal biomarker for this. There is a need to identify new potential useful biomarkers. Serum tryptase levels are valuable in the diagnosis of anaphylaxis, but are unable to detect all anaphylactic reactions. Additionally serial tryptase measurements are laborious in daily clinical practice.

中文翻译：

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使用基线和峰值血清类胰蛋白酶水平来诊断过敏反应：综述。


过敏反应的诊断依赖于暴露于潜在触发因素后的提示性临床病史。血清类胰蛋白酶浓度随着肥大细胞脱粒而增加，因此测量血清类胰蛋白酶水平以诊断过敏反应。目前尚无评估过敏反应中总血清肥大细胞类胰蛋白酶 (MCT) 的标准化方法。 2010年工作会议提出了诊断急性肥大细胞活化（aMCA）的共识方程（峰值MCT应为> 1.2x基线类胰蛋白酶+2 ng/L）。我们的目标是叙述性地回顾 2010 年工作会议以来的文献，检查共识方程和其他方程的使用，比较过敏反应期间的基线和峰值血清类胰蛋白酶。 PUBMED 和 EMBASE 的计算机书目检索辅以参考文献列表的手动检索。英语语言研究也包括在内。 11 项研究符合我们的纳入标准，共有 4551 名参与者。然而，只有四项涉及 653 名参与者的研究使用了共识方程。其他七项研究使用其他方法来比较峰值和基线血清类胰蛋白酶浓度。测量血清类胰蛋白酶水平对于过敏反应的诊断很有价值，但无法检测所有过敏反应。根据我们目前的文献综述，共识方程在过敏反应的诊断中没有得到充分利用。还需要探索可与峰值和基线血清类胰蛋白酶测量并行使用的其他生物标志物，以进一步确定诊断。血清类胰蛋白酶是过敏反应中研究最多的生物标志物，但仍远不是理想的生物标志物。需要识别新的潜在有用的生物标志物。 血清类胰蛋白酶水平对于过敏反应的诊断很有价值，但无法检测所有过敏反应。此外，在日常临床实践中连续测量类胰蛋白酶是很费力的。