The Normal Range of Baseline Tryptase Should Be 1 to 15 ng/mL and Covers Healthy Individuals With HαT

Peter Valent*, Gregor Hoermann, Patrizia Bonadonna, Karin Hartmann, Wolfgang R. Sperr, Sigurd Broesby-Olsen, Knut Brockow, Marek Niedoszytko, Olivier Hermine, Yannick Chantran, Joseph H. Butterfield, Georg Greiner, Melody C. Carter, Vito Sabato, Deepti H. Radia, Frank Siebenhaar, Massimo Triggiani, Theo Gülen, Ivan Alvarez-Twose, Thomas StaudingerLudwig Traby, Karl Sotlar, Andreas Reiter, Hans Peter Horny, Alberto Orfao, Stephen J. Galli, Lawrence B. Schwartz, Jonathan J. Lyons, Jason Gotlib, Dean D. Metcalfe, Michel Arock, Cem Akin

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Physiological levels of basal serum tryptase vary among healthy individuals, depending on the numbers of mast cells, basal secretion rate, copy numbers of the TPSAB1 gene encoding alpha tryptase, and renal function. Recently, there has been a growing debate about the normal range of tryptase because individuals with the hereditary alpha tryptasemia (HαT) trait may or may not be symptomatic, and if symptomatic, uncertainty exists as to whether this trait directly causes clinical phenotypes or aggravates certain conditions. In fact, most HαT-positive cases are regarded as asymptomatic concerning mast cell activation. To address this point, experts of the European Competence Network on Mastocytosis (ECNM) and the American Initiative in Mast Cell Diseases met at the 2022 Annual ECNM meeting and discussed the physiological tryptase range. Based on this discussion, our faculty concluded that the normal serum tryptase range should be defined in asymptomatic controls, inclusive of individuals with HαT, and based on 2 SDs covering the 95% confidence interval. By applying this definition in a literature screen, the normal basal tryptase in asymptomatic controls (HαT-positive persons included) ranges between 1 and 15 ng/mL. This definition should avoid overinterpretation, unnecessary referrals, and unnecessary anxiety or anticipatory fear of illness in healthy individuals.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume11
Issue number10
Pages (from-to)3010-3020
ISSN2213-2198
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Hereditary alpha tryptasemia
  • Mast cell activation syndromes
  • Mastocytosis
  • Tryptase

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