Serum tryptase: an indicator of anaphylaxis following fluorescein angiography.
BACKGROUND
Anaphylaxis is a potentially fatal complication of fluorescein angiography. It is diagnosed by clinical signs. Serum beta-tryptase serves as a specific indicator of mast cell activation and of anaphylactic shock that can be detected by radioimmunoassay.


METHODS
This is a report on a 48-year-old woman who developed anaphylaxis during fluorescein angiography. This study investigates the role of beta-tryptase in anaphylactic shock resulting from intravenous fluorescein angiogram.


RESULTS
A serum sample of beta-tryptase collected at the time of an adverse reaction to fluorescein angiography was determined by radioimmunassay to be elevated above 20 ng/ml (normal level <1 ng/ml). This indicates massive mast cell activation and anaphylactic shock.


CONCLUSIONS
This case is the first in which elevated levels of beta-tryptase in serum indicated that the systemic adverse reaction to fluorescein was mast cell dependent. Additionally, beta-tryptase levels can be assayed to detect anaphylactic reactions several hours after a precipitating event.
Butrus
S I
SI
Department of Ophthalmology, Washington National Eye Center, DC, USA.
Negvesky
G J
GJ
Rivera-Velazques
P M
PM
Schwartz
L B
LB
D000707:Anaphylaxis / Q000139:chemically induced / Q000175:diagnosis* / Q000201:enzymology; D015415:Biomarkers / Q000097:blood; D053818:Chymases; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage / Q000009:adverse effects*; D005451:Fluorescein Angiography / Q000009:adverse effects*; D005654:Fundus Oculi; D006801:Humans; D007275:Injections, Intravenous; D008407:Mast Cells / Q000201:enzymology; D008875:Middle Aged; D011863:Radioimmunoassay; D012697:Serine Endopeptidases / Q000097:blood*; D053802:Tryptases
D015415:Biomarkers; D003287:Contrast Media; D012697:Serine Endopeptidases; C083294:chymase 2; D053818:Chymases; D053802:Tryptases; D019793:Fluorescein