Paediatric perioperative hypersensitivity: the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase.

Formula for mast cell activation in children POH diagnosis Paediatric POH Paired serum tryptase Performance of consensus formula Perioperative anaphylaxis Perioperative hypersensitivity Uneventful anaesthesia

Journal

BJA open
ISSN: 2772-6096
Titre abrégé: BJA Open
Pays: England
ID NLM: 9918419157906676

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 30 08 2023
accepted: 16 12 2023
medline: 23 1 2024
pubmed: 23 1 2024
entrez: 23 1 2024
Statut: epublish

Résumé

Paired sampling of acute (aST) and basal (bST) serum tryptase has been recommended when investigating patients with a suspected perioperative hypersensitivity (POH) reaction. In the current consensus formula, an aST value exceeding (1.2×bST+2) confirms mast cell activation. The current consensus formula has been validated in adults but not in children. We prospectively included 96 children who underwent uneventful anaesthesia and sampled serum tryptase at baseline and 60-90 min after induction. Tryptase changes were then compared with those in 94 children with suspected POH who were retrospectively included from four reference centres in Belgium, France, and Denmark. We observed a median decrease in serum tryptase during uneventful anaesthesia of 0.41 μg L This is the first study suggesting the need for an adjusted formula in children to identify perioperative mast cell activation as tryptase is significantly lowered during uneventful anaesthesia. We propose a new formula (aST>bST+0.71) which performs significantly better than the current consensus formula in our multicentric paediatric population.

Sections du résumé

Background UNASSIGNED
Paired sampling of acute (aST) and basal (bST) serum tryptase has been recommended when investigating patients with a suspected perioperative hypersensitivity (POH) reaction. In the current consensus formula, an aST value exceeding (1.2×bST+2) confirms mast cell activation. The current consensus formula has been validated in adults but not in children.
Methods UNASSIGNED
We prospectively included 96 children who underwent uneventful anaesthesia and sampled serum tryptase at baseline and 60-90 min after induction. Tryptase changes were then compared with those in 94 children with suspected POH who were retrospectively included from four reference centres in Belgium, France, and Denmark.
Results UNASSIGNED
We observed a median decrease in serum tryptase during uneventful anaesthesia of 0.41 μg L
Conclusions UNASSIGNED
This is the first study suggesting the need for an adjusted formula in children to identify perioperative mast cell activation as tryptase is significantly lowered during uneventful anaesthesia. We propose a new formula (aST>bST+0.71) which performs significantly better than the current consensus formula in our multicentric paediatric population.

Identifiants

DOI: 10.1016/j.bjao.2023.100254 PMID: 38261931 PMC: PMC10797541
pubmed: 38261931
doi: 10.1016/j.bjao.2023.100254
pii: S2772-6096(23)00133-8
pmc: PMC10797541
doi:

Types de publication

Journal Article

Langues

eng

Pagination

100254

Informations de copyright

© 2023 The Authors.

Auteurs

Nils Vlaeminck (N)

Department of Anaesthesiology, Antwerp University Hospital, Belgium.

Marie-Line van der Poorten (MV)

Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium.
Department of Paediatrics, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Belgium.

Cecilie Nygaard Madsen (C)

Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.

Birgitte Bech Melchiors (B)

Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.

Moïse Michel (M)

Aix-Marseille Université, MEPHI, Marseille, France.
IHU Méditerranée Infection, Marseille, France.
CHU Nîmes, Laboratoire d'Immunologie, Nîmes, France.

Constance Gonzalez (C)

Aix-Marseille Univ, University Hospitals of Marseille, Laboratoire d'Immunologie, Marseille, France.

Rik Schrijvers (R)

Department of Microbiology, Immunology and Transplantation, Faculty of Medicine, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.

Jessy Elst (J)

Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium.

Christel Mertens (C)

Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium.

Vera Saldien (V)

Department of Anaesthesiology, Antwerp University Hospital, Belgium.

Joana Vitte (J)

University of Reims Champagne-Ardenne, INSERM UMR-S 1205 P3CELL and Immunology Laboratory, University Hospital of Reims, Reims, France.

Lene H Garvey (LH)

Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Denmark.

Vito Sabato (V)

Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium.

Didier G Ebo (DG)

Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium.
Department of Immunology and Allergology, AZ Jan Palfijn Ghent, Ghent, Belgium.
Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.

Classifications MeSH