Serum tryptase as a biomarker of anaphylaxis in children in real clinical practice



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Abstract

BACKGROUND: Anaphylaxis is a severe, life-threatening systemic allergic reaction. Currently, the only biomarker of anaphylaxis recommended for use in Russian and international consensus documents is tryptase, with very limited data on the efficacy of its use in real clinical practice in children.

AIMS: To determine the frequency of measurement and diagnostic significance of tryptase level estimation in children with anaphylaxis within the recommended time frame in real clinical practice, as well as its relationship with the age of patients and the severity of symptoms.

METHODS: The observational single-center prospective study included 128 patients aged 0 to 18 years who were hospitalized urgently in the State Budgetary Institution “Morozov Children's Hospital of Moscow” due to an episode of anaphylaxis in the period from May 2022 to April 2025 and were included in the Pediatric Moscow Anaphylaxis Register. The diagnosis of anaphylaxis was verified by an expert allergist-immunologist based on clinical criteria for anaphylaxis. Serum tryptase levels were measured in patients admitted to the hospital within 3 hours of the onset of symptoms of acute allergic reaction. The patients' clinical and laboratory parameters were entered into an online registry questionnaire and processed using a computer program, which is a system for data recording and analysis.

RESULTS: Of the 128 children, 52 (40.6%) had their tryptase levels measured within 3 hours of symptom onset. Among these, 15 (28.8%) showed elevated tryptase levels. For the 76 children who were not assessed (due to delayed hospitalization), a higher frequency of mild anaphylaxis was observed compared to those assessed for tryptase levels (31.6% vs 15.4%, p=0.037). No correlation was found between age and tryptase levels, though there was a trend toward older patients (median 12 years vs. 10 years, p=0.052) being within the timeframe for tryptase measurement. Severity of reaction did not affect tryptase concentrations.

CONCLUSIONS: In clinical practice, tryptase levels can be measured within 3 hours of symptom onset in less than half of patients, with only one third showing elevated levels. Delayed hospital arrival in patients with mild anaphylaxis is likely to delay diagnosis and treatment.

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About the authors

Aleksandra D. Medvedeva

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University

Author for correspondence.
Email: alexZZander@list.ru
ORCID iD: 0009-0006-0898-7905
SPIN-code: 2010-5257

MD of Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery

Россия

Sergey B. Zimin

Morozov Children's Municipal Clinical Hospital

Email: 23otd@morozdgkb.ru
ORCID iD: 0000-0002-4514-8469
SPIN-code: 4363-1578

MD

Россия, Moscow

Natalia V. Esakova

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University of the Russian Ministry of Health

Email: env007@rambler.ru
ORCID iD: 0000-0001-8792-2670
SPIN-code: 6924-9726

MD, Cand. Sci. (Med.)

Россия, Moscow

Ekaterina I. Кovtun

Morozov Children's Municipal Clinical Hospital

Email: EKovtun@morozdgkb.ru
ORCID iD: 0000-0002-1508-314X
SPIN-code: 6219-0640

MD

Россия, Moscow

Elena S. Busova

Morozov Children's Municipal Clinical Hospital

Email: ESBusova@morozdgkb.ru
ORCID iD: 0009-0009-9121-5501

MD

Россия, Moscow

Zareta S. Bzhekshieva

Morozov Children's Municipal Clinical Hospital

Email: ZBzhekshieva@morozdgkb.ru
ORCID iD: 0009-0009-7375-7526
SPIN-code: 9844-6674

MD

Россия, Moscow

Natalia M. Zaikova

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Department of Innovative Pediatrics and Pediatric Surgery of the Faculty of Additional Professional Education of the Pirogov Russian National Research Medical University

Email: zaikova@pedklin.ru
ORCID iD: 0000-0002-8166-2449
SPIN-code: 2821-7781

MD, Dr. Sci. (Med.), Professor

Россия, Moscow, Russian Federation

Valery V. Gorev

Morozov Children's Municipal Clinical Hospital

Email: mdgkb@zdrav.mos.ru
ORCID iD: 0000-0001-8272-3648
SPIN-code: 8944-9664

MD, Cand. Sci. (Med.)

Россия, Moscow

Alexander N. Pampura

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University of the Russian Ministry of Health

Email: apampura@pedklin.ru
ORCID iD: 0000-0001-5039-8473
SPIN-code: 9722-7961

MD, Dr. Sci. (Med.), Professor

Россия, Moscow

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