Why the 20%+2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome

Peter Valent*, Patrizia Bonadonna, Karin Hartmann, Sigurd Broesby-Olsen, Knut Brockow, Joseph H. Butterfield, Massimo Triggiani, Jonathan J. Lyons, H. N. G. Oude Elberink, Michel Arock, Dean D. Metcalfe, Cem Akin

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

23 Citations (Scopus)

Abstract

Mast cell activation syndrome (MCAS) is a condition characterized by recurrent episodes of clinically relevant, systemic, severe reactions to mast cell (MC)-derived mediators released in the context of anaphylaxis or another acute MC-related event. It is important to document MC involvement in these reactions in order to establish the diagnosis MCAS. The most specific and reliable marker of systemic MC activation is an acute and substantial event-related (transient) increase in the serum tryptase level over the individual's baseline value. However, the baseline level of tryptase varies depending on the underlying disease and the genetic background. For example, an estimated 3-5% of healthy individuals exhibit duplications or multiple copies of the TPSAB1 gene encoding for alpha-tryptase, and over 30% of all patients with myeloid neoplasms, including mastocytosis, have elevated basal tryptase levels. Therefore, it is of utmost importance to adjust the event-related diagnostic (MCAS-confirming) increase in tryptase over the individual baseline in a robust approach. To address this challenge, the 20% + 2 formula was proposed by the consensus group in 2012. Since then, this approach has been validated in clinical practice by independent groups and found to be sound. In the current article, we discuss the emerging importance and value of the 20% + 2 formula in clinical practice and its role as a criterion of severe systemic MC activation and MCAS. (C) 2019 S. Karger AG, Basel

Original languageEnglish
Pages (from-to)44-51
Number of pages8
JournalInternational Archives of Allergy and Immunology
Volume180
Issue number1
DOIs
Publication statusPublished - 2019

Keywords

  • Mast cells
  • Allergy
  • Anaphylaxis
  • IgE
  • Mast cell activation
  • Tryptase
  • HYMENOPTERA VENOM ALLERGY
  • ELEVATED SERUM TRYPTASE
  • ANAPHYLACTIC REACTIONS
  • BASE-LINE
  • MASTOCYTOSIS
  • DISORDERS
  • RISK
  • MECHANISMS
  • HISTAMINE
  • CIRCULATION

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