Severe food allergy reactions are associated with α-tryptase

Abigail Lang; Stephanie Kubala; Megan C Grieco; Allyson Mateja; Jacqueline Pongracic; Yihui Liu; Pamela A Frischmeyer-Guerrerio; Rajesh Kumar; Jonathan J Lyons

doi:10.1016/j.jaci.2023.07.014

Severe food allergy reactions are associated with α-tryptase

J Allergy Clin Immunol. 2023 Oct;152(4):933-939. doi: 10.1016/j.jaci.2023.07.014. Epub 2023 Aug 7.

Authors

Abigail Lang¹, Stephanie Kubala², Megan C Grieco³, Allyson Mateja⁴, Jacqueline Pongracic⁵, Yihui Liu⁶, Pamela A Frischmeyer-Guerrerio², Rajesh Kumar⁵, Jonathan J Lyons⁶

Affiliations

¹ Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: alang@luriechildrens.org.
² Food Allergy Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
³ Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga.
⁴ Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Md.
⁵ Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill.
⁶ Translational Allergic Immunopathology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

Abstract

Background: Increased TPSAB1 copy numbers encoding ⍺-tryptase are associated with severe reactions in adults with Hymenoptera venom allergy, systemic mastocytosis, and idiopathic anaphylaxis.

Objective: The primary objective was to assess the association between ⍺-tryptase and severity of food allergy.

Methods: A total of 119 subjects underwent tryptase genotyping; 82 of them were from an observational food allergy cohort at the National Institute of Allergy and Infectious Disease (NIAID), and 37 were from a cohort of children who reacted to peanut oral food challenge (OFC) at Lurie Children's Hospital of Chicago. The primary predictor was presence or absence of ⍺-tryptase. The primary outcomes for both cohorts were measures of severity of food allergy reaction. Secondary outcomes included OFC symptom scores (Bock/Practical Allergy [PRACTALL] and Severity Grading Score for Acute Reactions [SGSAR]). Correlation between total α-tryptase isoforms and OFC scores was also assessed to account for gene dosage effects.

Results: Among the subjects in the NIAID cohort, the presence of ⍺-tryptase was associated with a higher prevalence of food-triggered anaphylaxis than in those with only β-tryptase (P = .026). Similarly, only 1 of 6 subjects in the OFC cohort with only β-tryptase (17%) had a severe reaction, whereas 20 of 31 of subjects with α-tryptase (65%) had a severe reaction (P = .066). Subjects with ⍺-tryptase also had higher total SGSAR scores than did the subjects with no ⍺-tryptase (P = .003). In addition, there were also significant positive correlations between ⍺-tryptase isoform copy numbers and both higher total SGSAR and Bock/PRACTALL OFC scores (P = .008 and P = .003, respectively).

Conclusion: The presence of α-tryptase in subjects is correlated with a higher prevalence of anaphylaxis or severe reaction to food than in subjects without any α-tryptase.

Keywords: Food allergy; anaphylaxis; hereditary α-tryptasemia; peanut allergy; α-tryptase.

Publication types

Research Support, N.I.H., Intramural
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Allergens
Anaphylaxis* / diagnosis
Anaphylaxis* / epidemiology
Anaphylaxis* / etiology
Arthropod Venoms*
Child
Food Hypersensitivity* / epidemiology
Humans
Tryptases

Substances

Tryptases
Allergens
Arthropod Venoms

Abstract

Publication types

MeSH terms

Substances

Grants and funding