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Gagnsemi serum-tryptasamælinga hjá sjúklingum með möguleg einkenni bráðaofnæmiskasts á bráðamóttöku 2011–2018

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Authors
Karólína Hansen1
Hjalti Már Björnsson
María I. Gunnbjörnsdóttir
Issue Date
2021-10

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Other Titles
Utility of serum tryptase in Emergency Department patients with possible anaphylaxis
Citation
Karólína Hansen, Hjalti Már Björnsson, María I. Gunnbjörnsdóttir. Gagnsemi serum-tryptasamælinga hjá sjúklingum með möguleg einkenni bráðaofnæmiskasts á bráðamóttöku 2011–2018. Læknablaðið. 2021; 107(10): 470-75. doi 10.17992/lbl.2021.10.656.
Abstract
INNGANGUR Tiltölulega einfalt er að greina bráðaofnæmiskast í dæmigerðum tilfellum en birtingarmyndin getur þó verið fjölbreytt. Sýnt hefur verið fram á að hjá einstaklingum með ódæmigerð einkenni getur mæling á s-tryptasa verið gagnleg til viðbótar við klíníska greiningu læknis. Einnig nýtist mæling á s-tryptasa til að greina sjúkdóminn mastfrumnager. Byrjað var að nota s-tryptasamælingar á bráðamóttöku Landspítala árið 2011. Markmið rannsóknarinnar var að meta tíðni og gagnsemi s-tryptasamælinga hjá sjúklingum á bráðamóttöku. EFNIVIÐUR OG AÐFERÐIR Með leyfi siðanefndar heilbrigðisrannsókna á Landspítala voru skoðuð öll þau tilvik þar sem blóðsýni var sent frá bráðamóttöku til mælingar á s-tryptasa á ónæmisfræðideild á árunum 2011-2018. Upplýsingum var safnað úr sjúkraskrám um uppvinnslu og meðferð sjúklinga á bráðamóttöku og hjá ofnæmislækni. NIÐURSTÖÐUR Alls voru 214 sýni send til s-tryptasamælingar. Tryptasi var hækkaður (>12 μg/L) í 36 tilvikum. Konur voru 131 (61,2%) og meðalaldur var 40,6 ár. Algengi einkenna voru: húð- og slímhúðareinkenni 86,4%, blóðrásareinkenni 48,1%, öndunarfæraeinkenni 49,5% og meltingarfæraeinkenni 36,0%. Af 126 endurkomusjúklingum mat ofnæmislæknir 65 tilfelli sem bráðaofnæmiskast. Af þeim uppfylltu fjórir einstaklingar ekki klínísk greiningarskilmerki bráðaofnæmiskasts en voru með hækkuð tryptasagildi. Næmi s-tryptasamælingar var 40,9% og sértæki 97,1%. Ekkert tilfelli leiddi til greiningar mastfrumnagers. ÁLYKTANIR Mælingar á s-tryptasa hjá sjúklingum á bráðamóttöku með möguleg einkenni bráðaofnæmiskasts virðast veita gagnlegar upplýsingar til greiningar sjúkdómsins til viðbótar við klínískt mat. Mælingin er sértæk en með lágt næmi. Mælingarnar hafa ekki leitt til fjölgunar greininga á mastfrumnageri.
BACKGROUND Diagnosing anaphylaxis is often straightforward but can be challenging if the presentation is atypical. In patients with atypical symptoms suspected to be due to an acute allergic reaction, s-tryptase can give additional diagnostic information. Measuring s-tryptase is also helpful in diagnosing mastocytosis. Obtaining s-tryptase levels has been done in the emergency department (ED) at Landspitali since 2011. The aim of this study was to evaluate the benefit of obtaining s-tryptase levels in the ED. METHODS With institutional review board approval, all cases where s-tryptase level was obtained in ED patients from 2011–2018 were retrospectively reviewed. A database was collected including information on patient demographics, presenting symptoms, treatment, diagnosis, s-tryptase level and follow up. RESULTS A total of 214 patients had a s-tryptase level measured. Serum tryptase was elevated (>12 μg/L) in 36 cases. Females were 131 and average age 40.6 years. Of the patients, 86.4% had skin or mucosal symptoms, 48.1% cardiovascular symptoms, 49.5% respiratory symptoms and 36.0% had gastrointestinal symptoms. An allergist reviewed 126 returning patients and 65 were considered to have had an episode of anaphylaxis. Of those 65 were 4 patients which did not meet the diagnostic criteria for anaphylaxis but had raised s-tryptase levels. Sensitivity of s-tryptase measurement was 40.9% and specificity 97.1%. CONCLUSIONS Obtaining a s-tryptase level from ED patients with possible anaphylaxis seems to be useful in atypical cases. The measurement is specific but not sensitive. No cases of mastocytosis were identified in the patient cohort.
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Icelandic Journal Articles (Peer Reviewed)

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