Serum tryptase combined with clinical scoring improves diagnosis and management of chemotherapy-related hypersensitivity

Aims: Chemotherapy-related hypersensitivity reactions (HSRs) range from mild symptoms to life-threatening anaphylaxis. Accurate differentiation is essential for treatment decisions. This study aimed to evaluate the diagnostic value of combining serum tryptase levels with a standardized clinical severity score in patients who developed chemotherapy-induced HSRs. Methods: This retrospective, single-center study included adult cancer patients who developed HSRs during chemotherapy and underwent serum tryptase testing within 1-4 hours of symptom onset. Anaphylaxis severity was classified using Brown’s scoring system. The relationship between tryptase levels, clinical severity, and subsequent treatment modifications was analyzed, and diagnostic performance for predicting severe anaphylaxis was assessed using ROC analysis. Results: Ninety-seven patients were included. Elevated tryptase levels (≥11.4 ng/ml) were detected in 38% of patients and were strongly associated with severe anaphylaxis scores (≥5) (p