Severe food allergy reactions are associated with a-tryptase

Increased TPSAB1 copy number encoding ?-tryptase is associated with severe reactions in adults with Hymenoptera venom allergy, systemic mastocytosis, and idiopathic anaphylaxis. The primary objective was to assess the association between ?-tryptase and food allergy severity. 119 subjects underwent tryptase genotyping, 82 from an observational food allergy cohort at National Institute of Allergy and Infectious Diseases (NIAID) and 37 from a cohort of children who reacted to peanut oral food challenge (OFC) at Lurie Children's. The primary predictor was presence or absence of ?-tryptase. The primary outcomes for both cohorts were measures of food allergy reaction severity. Secondary outcomes included OFC symptom scores [(Bock/PRACTALL and Severity Grading Score for Acute Reactions (SGSAR)]. Correlation between total a-tryptase isoforms and OFC scores was also assessed to account for gene dosage effects. The presence of ?-tryptase was associated with increased prevalence of food-triggered anaphylaxis as compared to those with only ß-tryptase (p=0.026) in the NIAID cohort. Similarly, only 1/6 (17%) subjects in the OFC cohort with only ß-tryptase had a severe reaction while 20/31 (65%) of subjects with a-tryptase had a severe reaction (p=0.066). Subjects with ?-tryptase also had higher total SGSAR scores as compared to subjects with no ?-tryptase (p=0.003). In addition, there were also significant positive correlations between ?-tryptase isoform copy numbers and both higher total SGSAR and Bock/PRACTALL OFC scores (p=0.008 and 0.003, respectively). The presence of a-tryptase correlates with increased prevalence of anaphylaxis or severe reaction to food as compared to subjects without any a-tryptase. Copyright © 2023. Published by Elsevier Inc.

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