Serum tryptase combined with clinical scoring improves diagnosis and management of chemotherapy-related hypersensitivity

Abstract

Aims: Chemotherapy-related hypersensitivity reactions (HSRs) range from mild symptoms to life-threatening anaphylaxis. Accurate differentiation is essential for treatment decisions. This study aimed to evaluate the diagnostic value of combining serum tryptase levels with a standardized clinical severity score in patients who developed chemotherapy-induced HSRs. Methods: This retrospective, single-center study included adult cancer patients who developed HSRs during chemotherapy and underwent serum tryptase testing within 1-4 hours of symptom onset. Anaphylaxis severity was classified using Brown’s scoring system. The relationship between tryptase levels, clinical severity, and subsequent treatment modifications was analyzed, and diagnostic performance for predicting severe anaphylaxis was assessed using ROC analysis. Results: Ninety-seven patients were included. Elevated tryptase levels (≥11.4 ng/ml) were detected in 38% of patients and were strongly associated with severe anaphylaxis scores (≥5) (p<0.001). Among patients with elevated tryptase, 78% required treatment modification or desensitization, compared with 19% of those with normal levels. Serum tryptase demonstrated excellent predictive accuracy for severe anaphylaxis (AUC: 0.91). A small subgroup exhibited severe clinical features despite normal tryptase values, highlighting the need for combined clinical and biochemical assessment. Conclusion: Integrating serum tryptase measurement with standardized anaphylaxis scoring provides a reliable and practical approach to distinguishing true anaphylaxis from non-specific HSRs. This combined assessment improves diagnostic precision, supports timely therapeutic decisions, and may reduce unnecessary treatment modifications in oncology practice.

Keywords

• Chemotherapy
• hypersensitivity
• anaphylaxis
• serum tryptase
• clinical scoring
• oncology practice

Kemoterapi ilişkili hipersensitivite reaksiyonlarında serum triptaz ve klinik skorlama yaklaşımının tanısal ve yönetimsel değeri

Abstract

Giriş/Amaç: Kemoterapiye bağlı aşırı duyarlılık reaksiyonları (HSR) hafif belirtilerden yaşamı tehdit eden anafilaksiye kadar uzanabilir. Bu çalışma, kemoterapi sırasında HSR gelişen hastalarda serum triptaz düzeylerinin ve standart anafilaksi skorlamasının birlikte kullanılmasının tanısal değerini değerlendirmeyi amaçlamıştır. Gereç ve Yöntem: Retrospektif, tek merkezli bu çalışmaya kemoterapi sırasında HSR gelişen ve semptom başlangıcından sonraki 1–4 saat içinde serum triptaz düzeyi ölçülen erişkin hastalar dahil edildi. Anafilaksi şiddeti Brown skorlama sistemiyle sınıflandırıldı ve triptaz düzeyleri ile klinik şiddet ve tedavi modifikasyonları arasındaki ilişki analiz edildi. Bulgular: Toplam 97 hasta incelendi. Hastaların %38’inde triptaz ≥11.4 ng/mL olup bu durum ciddi anafilaksi ile anlamlı şekilde ilişkiliydi (p<0.001). Triptazı yüksek olan hastaların %78’inde tedavi değişikliği veya desensitizasyon gerekmişken, normal düzeylerde bu oran %19’du. Serum triptazı ciddi anafilaksiyi öngörmede yüksek doğruluk gösterdi (AUC: 0.91). Bazı hastalarda triptaz normal olmasına rağmen klinik olarak ciddi reaksiyon izlendi. Sonuç: Serum triptaz ölçümü ile standart anafilaksi skorunun birlikte kullanılması, kemoterapi ilişkili HSR’ların değerlendirilmesinde güvenilir ve pratik bir yaklaşım sunar. Bu yöntem tanısal doğruluğu artırarak uygun tedavi kararlarının verilmesini destekler.

Keywords

• Kemoterapi
• Hipersensitivite
• Anafilaksi
• Serum triptaz
• Klinik skorlama

References

1. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004;114(2):371-376. doi:10.1016/j.jaci.2004.04.029
2. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006;26(3):451-463. doi: 10.1016/j.iac.2006.05.010
3. Scherer K, Brockow K. Mast cell tryptase: marker and mediator in anaphylaxis. Curr Allergy Asthma Rep. 2021;21(2):6. doi:10.1007/s11882-020-00977-8
4. Picard M, Castells MC. Reactions to chemotherapeutic agents: emphasis on hypersensitivity responses and the role of desensitization. Curr Allergy Asthma Rep. 2020;20(7):26. doi:10.1007/s11882-020-00937-2
5. Castells M. Drug hypersensitivity and desensitizations in oncology: molecular mechanisms and clinical practice. Allergy. 2020;75(12):2890-2898. doi:10.1111/all.14344
6. Caimmi S, Arasi S, Castagna L, Liotti L, Giuffrida G, Crisafulli G. Hypersensitivity reactions to chemotherapeutic drugs: diagnosis and management. Curr Treat Options Allergy. 2021;8:1-16. doi:10.1007/s405 21-020-00270-y
7. Kanny G, Moneret-Vautrin DA, Morisset M, Beaudouin E, Sainte-Laudy J. Non-IgE mediated hypersensitivity to drugs: mechanisms and clinical aspects. Eur Ann Allergy Clin Immunol. 2022;54(1):7-15. doi:10.23822/E urAnnACI.1764-1489.233
8. Isabwe GA, Garcia Neuer M, de las Vecillas Sanchez L, Lynch DM, Marquis K, Castells M. Hypersensitivity reactions to therapeutic monoclonal antibodies: phenotypes and endotypes. J Allergy Clin Immunol Pract. 2020;8(6):1658-1668. doi:10.1016/j.jaip.2020.02.031

9. Madrigal-Burgaleta R, Berges-Gimeno MP, Pereira DA, Bobolea I, Valero A. Management of drug hypersensitivity reactions in oncology: practical aspects. Curr Treat Options Allergy. 2021;8:54-66. doi:10.1007/s 40521-021-00286-2
10. Szebeni J. Complement activation-related pseudoallergy: a new class of drug-induced acute immune toxicity. Toxicology. 2020;436:152421. doi: 10.1016/j.tox.2020.152421
11. Lyons JJ. Hereditary alpha tryptasemia: implications for diagnosis and treatment of mast cell disorders. Immunol Rev. 2020;296(1):123-132. doi: 10.1111/imr.12877
12. Bonadonna P, Bonifacio M, Lombardo C, Zanotti R. Mast cell activation in cardiovascular events. Curr Allergy Asthma Rep. 2020;20(9):47. doi: 10.1007/s11882-020-00943-4
13. De Schryver S, Halbrich M, Clarke A, La Vieille S, Eisman H, Alizadehfar R. Tryptase levels in children presenting with anaphylaxis: single center experience and literature review. J Allergy Clin Immunol Pract. 2020;8(6):2236-2243. doi:10.1016/j.jaip.2020.02.037