title: Interleukin 6 and C-reactive protein levels in patients with acute allergic reactions: an emergency department-based study.
abstract: BACKGROUND
  Elevations of interleukin 6 (IL-6) have been described in drug-induced anaphylaxis. Although IL-6 is well known to stimulate an acute phase response, profiling acute phase protein levels, such as C-reactive protein (CRP), has, to our knowledge, never been performed in patients with acute allergic reactions.
  
  
  OBJECTIVE
  To examine the pattern of IL-6 and CRP levels in patients with acute allergic reactions and to relate these to relevant clinical and laboratory parameters.
  
  
  METHODS
  Plasma CRP and serum IL-6 levels were determined in 85 adult emergency department patients. These patients had been previously studied with questionnaires, physical examinations, and histamine/tryptase levels. Clinical and historical features were related to CRP and IL-6 levels. CRP and IL-6 levels were also examined for relationships with histamine and tryptase levels.
  
  
  RESULTS
  CRP and IL-6 levels were significantly correlated with one another in the study patients (Spearman p = 0.36, P = 0.0008). Similar to histamine levels, IL-6 levels were significantly correlated with the extent of erythema manifested by the study patients. The extent of erythema was independently predicted by both IL-6 and histamine levels. Histamine levels were negatively correlated with CRP levels (Spearman p = -0.32, P = 0.003). Unlike histamine levels, IL-6 and CRP did not show significant relationships with the extent or presence of urticaria/angioedema or the presence of wheezing. IL-6 levels were correlated with the duration of symptoms before serologic sampling. An inverse correlation was observed between IL-6 levels and mean arterial blood pressure. Multivariate modeling showed significant independent effects from mean arterial pressure, duration of symptoms, erythema extent, and age in predicting IL-6 levels. Tryptase levels were higher in patients whose IL-6 levels were >20 pg/mL.
  
  
  CONCLUSIONS
  CRP and IL-6 levels are not simple surrogate markers for histamine or tryptase release by mast cells or basophils in acute allergic reactions. Increasing IL-6 levels relate to greater erythema extent, lower mean arterial blood pressure, and a longer duration of symptoms. It would be interesting to speculate that CRP and IL-6 increases characterize a late-phase response in immediate hypersensitivity reactions. In this perspective, the inverse relationship between CRP and histamine levels could be explained. As histamine levels are waning, CRP levels are increasing. Timed studies for histamine and CRP/IL-6 levels in allergic reactions are necessary to confirm this hypothesis.
authors.affiliation: Department of Medicine, Saint Vincents Hospital & Medical Center of New York-New York Medical College, New York 10011, USA. robert_lin@nymc.edu
authors.forename: R Y
authors.initials: RY
authors.lastname: Lin
authors.forename: M R
authors.initials: MR
authors.lastname: Trivino
authors.forename: A
authors.initials: A
authors.lastname: Curry
authors.forename: G R
authors.initials: GR
authors.lastname: Pesola
authors.forename: R J
authors.initials: RJ
authors.lastname: Knight
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.forename: L
authors.initials: L
authors.lastname: Bakalchuk
authors.forename: C
authors.initials: C
authors.lastname: Tenenbaum
authors.forename: R E
authors.initials: RE
authors.lastname: Westfal
mesh_terms: D000208:Acute Disease; D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis / Q000276:immunology*; D002097:C-Reactive Protein / Q000096:biosynthesis*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D006632:Histamine / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D012697:Serine Endopeptidases / Q000097:blood; D053802:Tryptases
chemical_list: D015850:Interleukin-6; D006632:Histamine; D002097:C-Reactive Protein; D012697:Serine Endopeptidases; D053802:Tryptases