title: Tryptase as severity marker in drug provocation tests.
abstract: BACKGROUND
  In the absence of objective symptoms, it is difficult to assess an adverse reaction during drug provocation testing. We evaluated the value of serum tryptase levels to distinguish between positive, negative and, even more important, so-called 'hysterical' reactions (conversion symptoms). The latter are occasionally observed in drug provocation tests when the patient experiences ambiguous subjective symptoms.
  
  
  METHODS
  In a prospective single-center study, 303 patients underwent 785 drug provocation tests. Blood was taken for tryptase measurement on each test day before and after drug challenge, and the changes in serum tryptase levels in patients with no reactions were compared with those who experienced immediate reactions to a drug.
  
  
  RESULTS
  Thirty-four of 785 drug provocations were clinically judged as being positive. Despite objective symptoms, median serum tryptase values in the afternoon were even lower than baseline levels. However, this decrease was not statistically significant. In the 751 patients suffering no objective reactions, the median values of post-testing tryptase values were statistically significantly decreased as compared with pretesting values.
  
  
  CONCLUSIONS
  The measurement of serum tryptase levels does not appear to be helpful to differentiate mild allergic or nonallergic reactions from 'hysterical' ones. The milder decrease in the group with objective drug reactions might indicate slight mast cell activation in some patients. More severe clinical drug reactions led to stronger mast cell degranulation. Mild reactions did not increase the tryptase levels consistently.
authors.affiliation: Department of Environmental Dermatology and Venereology, Medical University Graz, Graz, Austria. peter.komericki@meduni-graz.at
authors.forename: P
authors.initials: P
authors.lastname: Komericki
authors.forename: E
authors.initials: E
authors.lastname: Arbab
authors.forename: R
authors.initials: R
authors.lastname: Grims
authors.forename: B
authors.initials: B
authors.lastname: Kränke
authors.forename: W
authors.initials: W
authors.lastname: Aberer
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D001241:Aspirin / Q000009:adverse effects; D004008:Diclofenac / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000201:enzymology*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008528:Mefenamic Acid / Q000009:adverse effects; D008875:Middle Aged; D015242:Ofloxacin / Q000009:adverse effects; D010406:Penicillins / Q000009:adverse effects; D011446:Prospective Studies; D012697:Serine Endopeptidases / Q000097:blood*; D053802:Tryptases
chemical_list: D010406:Penicillins; D004008:Diclofenac; D000082:Acetaminophen; D008528:Mefenamic Acid; D008012:Lidocaine; D015242:Ofloxacin; D012697:Serine Endopeptidases; D053802:Tryptases; D001241:Aspirin