Elevated total serum tryptase levels in patients with postural orthostatic tachycardia syndrome (POTS): A case series

Total serum IgE, and Strongyloides - specific IgG and IgA antibodies were studied in 27 patients with parasitologically proven strongyloidiasis. Clinical manifestations in this case series were investigated by a restrospective study of the patient's records. Total serum IgE levels were elevated (greater than 250 IU/ml) in 59% of the patients (mean concentration = 1364 IU/ml). Parasite - specific IgG and IgA antibodies were detected by ELISA in the serum of 23 (85.2%) and 21 (77.8%) patients, respectively. Elevated serum IgE and clinical manifestations were not useful indexes of the presence of strongyloidiasis. On the other hand, our results support the view that serologic tests, particularly ELISA for detecting Strongyloides - specific IgG antibodies, can be usefully exploited for diagnostic purposes in strongyloidiasis.

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Hospital Records of Pain, Fatigue, or Circulatory Symptoms in Girls Exposed to Human Papillomavirus Vaccination: Cohort, Self-Controlled Case Series, and Population Time Trend Studies

American Journal of Epidemiology ◽

10.1093/aje/kwz284 ◽

2020 ◽

Vol 189 (4) ◽

pp. 277-285 ◽

Cited By ~ 4

Author(s):

Reimar Wernich Thomsen ◽

Buket Öztürk ◽

Lars Pedersen ◽

Sia Kromann Nicolaisen ◽

Irene Petersen ◽

...

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Time Trend ◽

Hpv Vaccination ◽

Case Series ◽

Public Confidence ◽

Postural Orthostatic Tachycardia Syndrome ◽

Hospital Records ◽

Trend Analyses ◽

Increased Risk

Abstract Human papillomavirus (HPV) vaccination has been associated with subsequent diffuse symptoms in girls, reducing public confidence in the vaccine. We examined whether girls have nonspecific outcomes of HPV vaccination, using triangulation from cohort, self-controlled case series (SCCS), and population time trend analyses carried out in Denmark between 2000 and 2014. The study population consisted of 314,017 HPV-vaccinated girls and 314,017 age-matched HPV-unvaccinated girls (cohort analyses); 11,817 girls with hospital records (SCCS analyses); and 1,465,049 girls and boys (population time trend analyses). The main outcome measures were hospital records of pain, fatigue, or circulatory symptoms. The cohort study revealed no increased risk among HPV vaccine-exposed girls, with incidence rate ratios close to 1.0 for abdominal pain, nonspecific pain, headache, hypotension/syncope, tachycardia (including postural orthostatic tachycardia syndrome), and malaise/fatigue (including chronic fatigue syndrome). In the SCCS analyses, we observed no association between HPV vaccination and subsequent symptoms. In time trend analyses, we observed a steady increase in these hospital records in both girls and (HPV-unvaccinated) boys, with no relationship to the 2009 introduction of HPV vaccine to Denmark’s vaccination program. This study, which had nationwide coverage, showed no evidence of a causal link between HPV vaccination and diffuse autonomic symptoms leading to hospital contact.

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Manometric Abnormalities in the Postural Orthostatic Tachycardia Syndrome: A Case Series

Digestive Diseases and Sciences ◽

10.1007/s10620-013-2865-9 ◽

2013 ◽

Vol 58 (11) ◽

pp. 3207-3211 ◽

Cited By ~ 8

Author(s):

Robert J. Huang ◽

Carlene L. Chun ◽

Karen Friday ◽

George Triadafilopoulos

Keyword(s):

Case Series ◽

Postural Orthostatic Tachycardia Syndrome

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Presence or Absence of Elevated Acute Total Serum Tryptase by Itself Is Not a Definitive Marker for an Allergic Reaction

Anesthesiology ◽

10.1097/aln.0000000000000584 ◽

2015 ◽

Vol 122 (3) ◽

pp. 713-714 ◽

Cited By ~ 30

Author(s):

Juraj Sprung ◽

Toby N. Weingarten ◽

Lawrence B. Schwartz

Keyword(s):

Allergic Reaction ◽

Total Serum ◽

Serum Tryptase

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Juvenile fibromyalgia: A call for diagnostic refinement, a case report

10.21203/rs.3.rs-78745/v1 ◽

2020 ◽

Author(s):

Elisha Peterson ◽

Caylynn Yao ◽

Sangeeta D. Sule ◽

Julia C. Finkel

Keyword(s):

Immune System ◽

Mood Disorders ◽

Orthostatic Intolerance ◽

Case Series ◽

Clinical Syndrome ◽

Somatic Complaints ◽

Pain Clinic ◽

Postural Orthostatic Tachycardia Syndrome ◽

Juvenile Fibromyalgia ◽

Immune System Dysfunction

Abstract BackgroundFibromyalgia is a clinical syndrome consisting of widespread musculoskeletal tenderness and various somatic complaints including nonrestorative sleep, mood disorders such as anxiety or depression, abdominal pain, and/or headaches. There is a great deal of heterogeneity in its expression which leads to difficulty in identifying predisposing factors. A singular review of patients in an academic pediatric pain clinic reveal immune system dysfunction, mood disorders, infection, postural orthostatic tachycardia syndrome, complex regional pain syndrome, and hypermobility are premorbid conditions. It is unclear if these premorbid conditions confer a distinct fibromyalgia clinical phenotype that can provide insight into targeted therapies. Current diagnostic measures for fibromyalgia do not allow for this level of discrimination and are not validated in children.Case Presentation20 children who demonstrated widespread musculoskeletal pain, tenderness to pressure on exam and multiple somatic complaints were diagnosed with fibromyalgia. Average time from start of pain to diagnosis is 2 years. Over half the patients have psychopathology, a third have an immune system dysfunction related to autoimmunity or an infectious exposure, a third with orthostatic intolerance or postural orthostatic tachycardia syndrome, a quarter relating to hypermobility, and a quarter of the cohort with dysmenorrhea were pre or comorbid conditions. Effective therapeutic regimens among patients varied widely from responding to medical monotherapy to multimodal treatment. Trigger point injections worsened pain in one fibromyalgia patient but decreased pain in another. Patients with comorbid autoimmunity report appreciating a difference between a flare in their arthritis as opposed to a flare in their fibromyalgia. Such varying responses within the same clinical syndrome suggest distinct phenotypes within fibromyalgia which is difficult to distinguish using our current diagnostic tools.ConclusionThere is a need for clear diagnostic criteria for both the recognition of juvenile fibromyalgia and tools to distinguish phenotypes within fibromyalgia. Currently, the recognition of clinical symptoms renders it an often-overlooked neuropathic pain condition. This case series suggest there are different phenotypes within fibromyalgia. Some patients respond remarkably to serotonin norepinephrine reuptake inhibitors alone whereas others require multidisciplinary therapy. A diagnostic tool refined to capture these nuances can facilitate targeted treatment recommendations.

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Characterization of a case series of Mastocytosis in a health care center in Cali, Colombia

10.21203/rs.3.rs-939459/v1 ◽

2021 ◽

Author(s):

Daniela Marulanda Sandoval ◽

Oscar Felipe Borja Montes ◽

Jose Leonel Zambrano Urbano ◽

Rigoberto Gomez Gutierrez

Keyword(s):

World Literature ◽

Case Reports ◽

Care Center ◽

Clinical Manifestations ◽

Case Series ◽

Poor Response ◽

Skin Lesions ◽

Serum Tryptase ◽

Health Care Center

Abstract Mastocytosis is a group of rare diseases, which correspond to neoplasms of the myeloid lineage. In Colombia there are only case reports and so far there are no studies of greater extension. We conducted a case series in which an active search was made for patients with a diagnosis of mastocytosis, either cutaneous (CM) or systemic (SM), from the total number of consultations between June 2004 and June 2019 in the reference hemato-oncologic center ("mastocytosis"). A total of 4 cases of CM and 3 cases of SM were identified. The most frequent clinical manifestations were skin lesions, which were present in 100% of patients; of these hyperpigmented macules were the most frequent findings. Serum tryptase (TS) levels were found to be elevated in 67% (2/3) of patients with DM. Both TS levels and mean absolute eosinophils were higher in patients with MS. In this case series we found a higher frequency of extracutaneous involvement, and in general a very poor response to the management. The findings of this series are comparable to those reported in world literature.

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Serum Tryptase Levels in AML at Diagnosis: A Multicenter Retrospective Study.

Blood ◽

10.1182/blood.v108.11.2358.2358 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2358-2358 ◽

Cited By ~ 1

Author(s):

Roberto Cairoli ◽

Carla B. Ripamonti ◽

Simonetta Granata ◽

Alessandro Beghini ◽

Patrizia Colapietro ◽

...

Keyword(s):

Elevated Serum ◽

Leukemia Cell ◽

Total Serum ◽

Control Group ◽

Serum Tryptase ◽

Kit Mutation ◽

Exact Test ◽

Fisher's Exact Test ◽

Mutational Status ◽

Fisher’S Exact Test

Abstract α and β-tryptase genes cluster on the short arm of human chromosome 16 and encode lineage-associated serine proteases that are abundantly expressed in mast-cells and, in trace amounts, in basophils. Under physiologic conditions no other myeloid cells express tryptases. However, in several myeloid leukemia cell lines and in AML blasts, the level of tryptase is elevated. In an attempt at correlating the levels of tryptase with cytogenetic features and the KIT and FLT3 mutational status, we analyzed serum samples collected at diagnosis from 150 AML and 57 ALL adult patients. The total serum concentration was determined by UniCAP 100 and UniCAP Tryptase Fluorenzyme Immunoassay Kit (Pharmacia-Upjohn, Uppsala, Sweden). The median value of tryptase level in the control group (50 healthy people; mean age 35 y, range 20–50; M/F= 26/24) amounted to less than 5 ng/ml, ranging from 1 to 15 ng/ml. We detected elevated tryptase levels (more than 15 ng/ml) in 66 out of 150 AML-patients (44%) and in 1 out of 57 ALL-patients (1.75%; median value 1.2 ng/ml) (p = < 0.0005, Fisher’s exact test ). In AMLs data showed that elevated tryptase values are significantly bound to patients with t(8;21) (n = 26, p = <0.0001) and inv(16) (n = 17, p = 0.035). Furthermore, we found a strong correlation between tryptase < 15 ng/ml and normal karyotype (n = 58 ; p = <0.0001). By contrast, we didn’t find any correlation between the levels of tryptase and t(15;17) (n = 12, p = 0.227), abnormal chr 5 or 7 (n = 9, p = 0.507), +8 (n = 6, p = 0.229), complex karyotype (n = 9, p = 1.000) or other abnormalities (n = 14, p = 0.778). A mutational screening for KIT (exon 2,8,10,11,and 17) and FLT3 (exon 14,15 and 20) was performed on 67/150 (45%) and 82/150 (55%) patients with AML, respectively. We recorded a significant association between high tryptase levels and the presence of KIT mutation (Fisher’s exact test: p = 0.012). No correlation was found between levels of tryptase and FLT3 mutational status (Fisher’s exact test: p = 0.803).In conclusion, data suggest that elevated serum tryptase levels at diagnosis are frequently associated with Core Binding Factor and with KIT mutated AML’s.

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State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Life ◽

10.3390/life11090870 ◽

2021 ◽

Vol 11 (9) ◽

pp. 870

Author(s):

Anca Angela Simionescu ◽

Ana Maria Alexandra Stanescu ◽

Florin-Dan Popescu

Keyword(s):

High Risk ◽

Pregnant Women ◽

Systemic Mastocytosis ◽

Interdisciplinary Approach ◽

Medical Emergency ◽

Total Serum ◽

In Vitro Tests ◽

Serum Tryptase

Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.

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Allergic BronchoPulmonary Aspergillosis in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.2806 ◽

2014 ◽

Vol 52 (196) ◽

pp. 1020-1023

Author(s):

Neha Agarwal ◽

Prajowl Shrestha ◽

Ramesh Chokhani

Keyword(s):

Pulmonary Tuberculosis ◽

Bronchial Asthma ◽

Allergic Bronchopulmonary Aspergillosis ◽

Case Series ◽

Total Serum ◽

Systemic Steroid ◽

Serum Ige ◽

Antitubercular Treatment ◽

Clinical Responses ◽

Time Of Presentation

Allergic BronchoPulmonary Aspergillosis is clinically under recognized and often misdiagnosed in Nepal. A total of 15 cases of ABPA were enrolled in this case series. Cases were followed up after the 3 months of start of treatment and clinical responses were assessed. The mean age of the patients was 33.06 ± 9.2 yrs. 80% were male. 26.6% patients were empirically on antitubercular treatment at the time of presentation. 40% patients were misdiagnosed and already treated as pulmonary Tuberculosis. 10 patients were previously treated as cases of refractory asthma. Majority of patients had significant eosinophillia and raised total serum IgE. All patients required treatment with bronchodilator and systemic steroid. 80% patients underwent remission with the treatment. Pulmonary Tuberculosis and refractory bronchial asthma are common condition that leads to the misdiagnosis of this disease. Keywords: ABPA; bronchial asthma; central bronchiectasis; eosinophil count; serum IgE.

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