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Basal Tryptase High Levels Associated with a History of Arterial Hypertension and Hypercholesterolemia Represent Risk Factors for Severe Anaphylaxis in Hymenoptera Venom-Allergic Subjects over 50 Years Old

Authors
  • Pastorello, Elide Anna
  • Borgonovo, Linda
  • Preziosi, Donatella
  • Schroeder, Jan Walter
  • Pravettoni, Valerio
  • Aversano, Maria Gloria
  • Pastori, Stefano
  • Bilò, Maria Beatrice
  • Piantanida, Marta
  • Losappio, Laura Michelina
  • Nichelatti, Michele
  • Rossi, Carlo Maria
  • Farioli, Laura
Type
Published Article
Journal
International Archives of Allergy and Immunology
Publisher
S. Karger AG
Publication Date
Dec 02, 2020
Volume
182
Issue
2
Pages
146–152
Identifiers
DOI: 10.1159/000510527
PMID: 33264768
Source
Karger
Keywords
License
Green
External links

Abstract

Introduction: Allergy to Hymenoptera venom (HV) may lead to life-threatening anaphylaxis. Some of the factors influencing the symptom’s severity are still undetermined. The aim of this study was to identify the clinical aspects associated with the most severe reactions in a population with HV allergy, by comparing clinical and immunochemical biomarkers between patients with previous local large reactions (LLRs) and systemic reactions (SRs). Methods: We selected adult patients with a history of HV allergy, with positive diagnostic tests and a correlation with one single Hymenoptera species. Age, gender, atopy, serum basal tryptase (sBT) value, total IgE, venom-specific IgE, history of hypertension, cardiovascular diseases, and hypercholesterolemia were compared between patients with previous LLRs and SRs. Results: 460 adult patients (381 SRs, 79 LLRs) were included. Age (p = 0.0097), male gender (p < 0.0001), arterial hypertension (p = 0.046), hypercholesterolemia (p = 0.009), and higher sBT levels (p = 0.0004) were significantly associated with severe reactions as independent variables. Moreover, considering the previous variables as risk factors, there was a significant and progressive increase in the odds of being Mueller III + IV as the number of positive variables increased. Patients with sBT ≥6.4 ng/mL adjusted for any of the positive variables had increased the risk of Mueller grade IV reaction (p < 0.0001). Conclusion: According to our results, older age, male gender, arterial hypertension, hypercholesterolemia, and increased levels of sBT ≥6.4 ng/mL are risk factors for severe anaphylaxis to HV in adults. Atopy and allergic asthma do not increase the risk of HV-induced SRs.

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