title: Basal serum tryptase as risk assessment for severe Hymenoptera sting reactions in elderly.
abstract: BACKGROUND
  Epidemiologic studies suggest that elderly people are more prone to develop severe anaphylactic reactions. However, the exact cause for this phenomenon remains unclear.
  
  
  OBJECTIVE
  To study the role of the serum tryptase as a diagnostic parameter for individual risk evaluation and its impact on the severity of allergic reactions in elderly people.
  
  
  METHODS
  Two hundred and seventy-four consecutive patients visiting the Department of Dermatology, Tübingen, Germany, who were diagnosed with honeybee or wasp venom allergy, were included in the study.
  
  
  RESULTS
  Sting reaction severity increased with increased age and tryptase levels (P = 0.001 and P = 0.0003, respectively). Furthermore, we find not only a general increment in tryptase levels in elderly people (P = 0.0001) but also a continuous increase in tryptase concentrations even below the cut-off (11.4 microg/l) with increasing age (P = 0.0026).
  
  
  CONCLUSIONS
  Our data confirm serum tryptase as a risk factor for severe anaphylactic reaction to hymenoptera stings. Furthermore, we give first evidence that basal serum tryptase levels increase continuously with age and being an indicator for either increased mast cell load or reactivity this can at least partly be responsible for the observed aggravated allergic reactions in elderly people. As those patients are at increased risk for life-threatening anaphylactic reactions, it should be considered to adjust VIT especially in elderly patients with elevated tryptase levels as recommended for patients with mastocytosis by increasing venom doses during VIT and by considering its life-long continuation.
authors.affiliation: Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Guenova
authors.forename: T
authors.initials: T
authors.lastname: Volz
authors.forename: M
authors.initials: M
authors.lastname: Eichner
authors.forename: W
authors.initials: W
authors.lastname: Hoetzenecker
authors.forename: U
authors.initials: U
authors.lastname: Caroli
authors.forename: G
authors.initials: G
authors.lastname: Griesinger
authors.forename: G
authors.initials: G
authors.lastname: Burow
authors.forename: V
authors.initials: V
authors.lastname: Mitev
authors.forename: T
authors.initials: T
authors.lastname: Biedermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000707:Anaphylaxis / Q000097:blood / Q000201:enzymology* / Q000276:immunology; D000818:Animals; D001180:Arthropod Venoms / Q000009:adverse effects / Q000276:immunology; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000097:blood / Q000201:enzymology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012882:Skin Tests; D053802:Tryptases / Q000097:blood*
chemical_list: D001180:Arthropod Venoms; D007073:Immunoglobulin E; D053802:Tryptases