Paediatric perioperative hypersensitivity: the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase
Nils Vlaeminck,
Marie-Line van der Poorten,
Cecilie Nygaard Madsen,
Birgitte Bech Melchiors,
Moïse Michel,
Constance Gonzalez,
Rik Schrijvers,
Jessy Elst,
Christel Mertens,
Vera Saldien,
Joana Vitte,
Lene H. Garvey,
Vito Sabato,
Didier G. Ebo
Affiliations
Nils Vlaeminck
Department of Anaesthesiology, Antwerp University Hospital, Belgium; Corresponding author.
Marie-Line van der Poorten
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
Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
Birgitte Bech Melchiors
Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
Aix-Marseille Univ, University Hospitals of Marseille, Laboratoire d’Immunologie, Marseille, France
Rik Schrijvers
Department of Microbiology, Immunology and Transplantation, Faculty of Medicine, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
Jessy Elst
Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium
Christel Mertens
Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium
Vera Saldien
Department of Anaesthesiology, Antwerp University Hospital, Belgium
Joana Vitte
University of Reims Champagne-Ardenne, INSERM UMR-S 1205 P3CELL and Immunology Laboratory, University Hospital of Reims, Reims, France
Lene H. Garvey
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
Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Belgium
Didier G. Ebo
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
Background: 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: 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: We observed a median decrease in serum tryptase during uneventful anaesthesia of 0.41 μg L−1 (–15.9%; PbST+0.71 was identified as the optimal cut-off point to identify mast cell activation. This new paediatric formula has higher sensitivity than the current consensus formula (53.2% vs 31.9%, PbST+0.71) which performs significantly better than the current consensus formula in our multicentric paediatric population.
