Abstract：
BACKGROUND: Diagnosing perioperative anaphylaxis (POA) is often challenging. Although a guideline recommends measuring tryptase rather than histamine, there is little evidence for this. We aimed to examine the diagnostic performance and appropriate timing of tryptase and histamine measurements for diagnosing anaphylaxis, and the association between Hypersensitivity Clinical Scoring Scheme (HCSS) scores and elevated biomarkers.
METHODS: We measured tryptase and histamine levels thrice: 30 min, 2 h, and at least 24 h after an anaphylactic event for patients with suspected anaphylaxis, and at the induction of general anesthesia and 30 min and 2 h after the start of surgery for control patients without a reaction. Absolute values and the magnitude and rate of change from baseline were evaluated. We determined the thresholds of tryptase and histamine levels with the best diagnostic performance and compared their performance.
RESULTS: Forty-five patients with perioperative anaphylaxis were included in this study. The control group included 30 patients with uneventful general anesthesia and 12 patients with a suspected but unconfirmed diagnosis of perioperative anaphylaxis. Comparison at the same measurement timings showed that tryptase generally had better diagnostic performance than histamine. Both showed better diagnostic performance when assessed using multiple measurements rather than a single measurement. The best diagnostic performance was seen with the percentage change in the higher tryptase value, whether measured at 30 min or 2 h after anaphylaxis onset, as compared to baseline. However, neither tryptase nor histamine levels correlated with HCSS scores.
CONCLUSIONS: Overall, tryptase showed better diagnostic performance than histamine. When multiple tryptase measurements are possible, parameters calculated using two acute phase measurements and the baseline level have better diagnostic performance.
METHODS: We measured tryptase and histamine levels thrice: 30 min, 2 h, and at least 24 h after an anaphylactic event for patients with suspected anaphylaxis, and at the induction of general anesthesia and 30 min and 2 h after the start of surgery for control patients without a reaction. Absolute values and the magnitude and rate of change from baseline were evaluated. We determined the thresholds of tryptase and histamine levels with the best diagnostic performance and compared their performance.
RESULTS: Forty-five patients with perioperative anaphylaxis were included in this study. The control group included 30 patients with uneventful general anesthesia and 12 patients with a suspected but unconfirmed diagnosis of perioperative anaphylaxis. Comparison at the same measurement timings showed that tryptase generally had better diagnostic performance than histamine. Both showed better diagnostic performance when assessed using multiple measurements rather than a single measurement. The best diagnostic performance was seen with the percentage change in the higher tryptase value, whether measured at 30 min or 2 h after anaphylaxis onset, as compared to baseline. However, neither tryptase nor histamine levels correlated with HCSS scores.
CONCLUSIONS: Overall, tryptase showed better diagnostic performance than histamine. When multiple tryptase measurements are possible, parameters calculated using two acute phase measurements and the baseline level have better diagnostic performance.
摘要：
背景：诊断围手术期过敏反应（POA）通常具有挑战性。尽管指南建议测量类胰蛋白酶而不是组胺，几乎没有证据证明这一点。我们旨在检查类胰蛋白酶和组胺测量诊断过敏反应的诊断性能和适当时机。以及超敏反应临床评分方案（HCSS）评分与升高的生物标志物之间的关联。
方法：我们测量了3次胰蛋白酶和组胺水平：30分钟，2h,以及疑似过敏反应的患者在过敏事件发生后至少24小时，在全麻诱导和手术开始后30分钟和2小时，对照组患者无反应。评估绝对值和相对于基线的变化幅度和速率。我们确定了具有最佳诊断性能的类胰蛋白酶和组胺水平的阈值，并比较了它们的性能。
结果：45例围手术期过敏反应患者被纳入本研究。对照组包括30例全身麻醉平稳的患者和12例怀疑但未确诊的围手术期过敏反应的患者。在相同测量时间的比较表明，类胰蛋白酶通常比组胺具有更好的诊断性能。当使用多个测量而不是单个测量进行评估时，两者都显示出更好的诊断性能。最好的诊断性能是观察到更高的类胰蛋白酶值的百分比变化，无论是在过敏反应发作后30分钟还是2小时测量，与基线相比。然而,类胰蛋白酶和组胺水平均不与HCSS评分相关。
结论：总体而言，类胰蛋白酶显示出比组胺更好的诊断性能。当多个类胰蛋白酶测量是可能的，使用两个急性期测量和基线水平计算的参数具有更好的诊断性能。
方法：我们测量了3次胰蛋白酶和组胺水平：30分钟，2h,以及疑似过敏反应的患者在过敏事件发生后至少24小时，在全麻诱导和手术开始后30分钟和2小时，对照组患者无反应。评估绝对值和相对于基线的变化幅度和速率。我们确定了具有最佳诊断性能的类胰蛋白酶和组胺水平的阈值，并比较了它们的性能。
结果：45例围手术期过敏反应患者被纳入本研究。对照组包括30例全身麻醉平稳的患者和12例怀疑但未确诊的围手术期过敏反应的患者。在相同测量时间的比较表明，类胰蛋白酶通常比组胺具有更好的诊断性能。当使用多个测量而不是单个测量进行评估时，两者都显示出更好的诊断性能。最好的诊断性能是观察到更高的类胰蛋白酶值的百分比变化，无论是在过敏反应发作后30分钟还是2小时测量，与基线相比。然而,类胰蛋白酶和组胺水平均不与HCSS评分相关。
结论：总体而言，类胰蛋白酶显示出比组胺更好的诊断性能。当多个类胰蛋白酶测量是可能的，使用两个急性期测量和基线水平计算的参数具有更好的诊断性能。
