Examples of patterns of tryptase elevations and interpretations in patients without kidney failure

Using acute and baseline levels of total tryptase:
Acute total tryptase (ng/mL) optimally collected between 0.5 to 2 hours after clinical onset	Baseline total tryptase either before onset or at least 24 hours after resolution of signs and symptoms	Interpretation of a mast cell disorder:
5	4	Normal
	1	Anaphylaxis
10	9	Normal or HaT^*
	5	Anaphylaxis
15	14	HaT^*
	5	Anaphylaxis
75	15	Anaphylaxis with HaT^*
	65	Systemic mastocytosis and/or HaT^*
22	13	Anaphylaxis with HaT^*
	25	Systemic mastocytosis or HaT^*

Measurements of acute and baseline total tryptase can provide support to the clinical diagnosis of anaphylaxis. The minimal elevation of an acute total tryptase level that is considered to be clinically significant (ie, indicative of mast cell activation) is ≥(2 + 1.2 × baseline tryptase levels). Tryptase values alone are not sufficient to make the diagnosis, however. A baseline sample occurring prior to the acute events should be retrieved or a follow-up sample should be drawn after full resolution of symptoms in order to accurately interpret the findings. High baseline tryptase levels increase the likelihood of underlying clonal mast cell disorders and/or HaT, which in turn increase the risk of more severe anaphylaxis events.

HaT: hereditary alpha-tryptasemia.

* HaT can be considered when baseline total tryptase levels are ≥8 ng/mL, but a tryptase level of ≥8 ng/mL does not exclude an underlying clonal mast cell disorder.

Graphic 58418 Version 11.0

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Examples of patterns of tryptase elevations and interpretations in patients without kidney failure