Asthma, rhinitis, other respiratory diseasesHistamine and tryptase levels in patients with acute allergic reactions: An emergency department–based study☆,☆☆
Section snippets
METHODS
Patients from the Saint Vincents Hospital Emergency Department were recruited between May 1998 and April 1999 in a study approved by the institutional review board. Adult patients (>18 years old) were considered for recruitment if they demonstrated the following syndromes after an ingested food or ingested, inhaled, or injected drug or after contact with latex: acute urticaria, acute angioedema, acute unexplained stridor, or acute pruritic rash. The study targeted patients whose symptoms had
RESULTS
Among 98 patients recruited for the study, 91 received randomized antihistamine protocol treatment. On chart review, 9 patients had allergic manifestations for greater than 12 hours (two patients each at 15 hours and 48 hours and one each at 19, 40, 58, 69, and 120 hours). These patients were still included in the analyses. Tryptase determinations were performed on 96 patients. Plasma histamine determinations were performed on 89 patients. Improper specimen handling (hemolysis or delayed
DISCUSSION
Many of the patients described in this report would not be considered as having severe anaphylaxis.12 Hypotension was observed in only two patients. No patients had loss of consciousness or required cardiopulmonary resuscitation or intubation. Despite this relatively mild clinical picture, about half of the patients had elevations of either histamine or total tryptase, which is consistent with a diagnosis of anaphylaxis. More patients had histamine elevations than tryptase elevations. This
Acknowledgements
We thank the emergency department nursing staff and Kevin Kavookjian for their help in this study.
References (23)
- et al.
Insect-sting challenge in 138 patients: relation between clinical severity of anaphylaxis and mast cell activation
J Allergy Clin Immunol
(1992) - et al.
Plasma histamine assay in anaphylactoid reactions of the anesthetized subject. Effects of collection methods and plasma preparation on measured histamine
Ann Fr Anesth Reanim
(1982) - et al.
Early biological markers of anaphylactoid reactions occurring during anesthesia
Ann Fr Anesth Reanim
(1992) - et al.
The potential clinical utility of serum alpha-protryptase levels
J Allergy Clin Immunol
(1999) - et al.
Clinical effects of combined anti-H1 and anti-H2 treatment in patients presenting with acute allergic syndromes: a randomized controlled trial
Ann Emerg Med
(1999) - et al.
Effects of infused histamine: analysis of the effects of H2- and H2-histamine receptor antagonists on cardiovascular and pulmonary responses
J Allergy Clin Immunol
(1981) - et al.
Importance of plasma (histamine and tryptase) and urinary (methylhistamine) in peri-anesthetic anaphylactic and/or anaphylactoid reactions
Allerg Immunol (Paris)
(1996) - et al.
Tryptase levels are not increased during vancomycin-induced anaphylactoid reactions
Anesthesiology
(1998) - et al.
Mechanisms of severe, immediate reactions to iodinated contrast material
Radiology
(1998) - et al.
Comparison of the levels of histamine, tryptase, and interleukin-6 for the investigation of anaphylactoid drug reactions
Allerg Immunol (Paris)
(1998)
An immunoassay for histamine
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Supported in part by National Institutes of Health grant AI20487 (L. B. S.)
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Reprint requests: Robert Y. Lin, MD, Saint Vincents Hospital, 153 W 11th St, New York, NY 10011.