Document Detail

Tryptase and histamine metabolites as diagnostic indicators of indolent systemic mastocytosis without skin lesions.
MedLine Citation:
PMID:  22435702     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Risk indicators of indolent systemic mastocytosis (ISM) in adults with clinical suspicion of ISM without accompanying skin lesions [urticaria pigmentosa (UP)] are lacking. This study aimed at creating a decision tree using clinical characteristics, serum tryptase, and the urinary histamine metabolites methylimidazole acetic acid (MIMA) and methylhistamine (MH) to select patients for bone marrow investigations to diagnose ISM.
METHODS: Retrospective data analysis of all adults, in whom bone marrow investigations were performed to diagnose ISM, was carried out.
RESULTS: In total, 142 patients were included. SM was absent in all 44 patients with tryptase <10 μg/l, in 45 of 98 (46%) patients with tryptase ≥10 μg/l and in 18 of 52 patients (35%) with tryptase >20 μg/l. Above 43 μg/l, all patients had ISM (n = 11). Male gender, insect venom anaphylaxis as presenting symptom, tryptase, MIMA, and MH were independent ISM predictors. If tryptase was ≥10 μg/l, the diagnostic accuracy of MIMA and MH was high (areas under the ROC curve 0.92).
CONCLUSIONS: In suspected patients without UP, the ISM risk is very low (if present at all) if tryptase is <10 μg/l. If tryptase is ≥10 μg/l, this risk depends on MIMA and MH, being low if these are normal, but high if these are elevated. Male gender and insect venom anaphylaxis are additional risk indicators. We recommend refraining from bone marrow examinations in suspected patients without UP if tryptase is <10 μg/l. Our results question the reliability of the minor diagnostic World Health Organization criterion of tryptase >20 μg/l.
J J van Doormaal; E van der Veer; P C van Voorst Vader; P M Kluin; A B Mulder; S van der Heide; S Arends; J C Kluin-Nelemans; J N G Oude Elberink; J G R de Monchy
Publication Detail:
Type:  Journal Article     Date:  2012-03-22
Journal Detail:
Title:  Allergy     Volume:  67     ISSN:  1398-9995     ISO Abbreviation:  Allergy     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-12     Completed Date:  2012-08-07     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  7804028     Medline TA:  Allergy     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  683-90     Citation Subset:  IM    
Copyright Information:
© 2012 John Wiley & Sons A/S.
Department of Allergology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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MeSH Terms
Bone Marrow / metabolism,  pathology
Histamine / metabolism
Imidazoles / urine*
Mastocytosis, Systemic / complications*,  diagnosis*
Methylhistamines / urine*
Middle Aged
ROC Curve
Retrospective Studies
Tryptases / blood*
Urticaria Pigmentosa / complications*
Reg. No./Substance:
0/Imidazoles; 0/Methylhistamines; 2625-49-2/methylimidazoleacetic acid; 51-45-6/Histamine; EC
Comment In:
Allergy. 2012 Sep;67(9):1190-1   [PMID:  22882359 ]

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