Examples of patterns of tryptase elevations and interpretations

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 consistent with:
5	4		Normal
	1		Anaphylaxis
10	9		Normal*
	5		Anaphylaxis
15	14		Normal*
	5		Anaphylaxis
75	15		Anaphylaxis*
	65		Systemic mastocytosis*
22	13		Anaphylaxis*
	25		Systemic mastocytosis*
Using acute levels of total and mature tryptase:
Total (normal 1 to 15 ng/mL)	Mature (<1 ng/mL)	Total/mature	Findings are consistent with:
3	<1	ND	Normal
10	<1	ND	Normal*
15	5	3	Anaphylaxis
75	65	1.2	Anaphylaxis
39	<1	>20	Systemic mastocytosis*

Measurements of acute and baseline total tryptase (top table) or total and mature (bottom table) 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. If only measurements of total tryptase are available, 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 risk for more severe anaphylaxis and increase the likelihood of underlying clonal mast cell disorders when higher than 11.4 ng/mL.

ND: not determined due to a denominator of <1 and a normal total tryptase level.

* Hereditary alpha-tryptasemia can be considered when baseline total tryptase levels are between >8 ng/mL.

Graphic 58418 Version 10.0

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Examples of patterns of tryptase elevations and interpretations