We read with great interest the valuable comments of Sprung etal. on the diagnostic value of total tryptase in allergic events. This group, which has been a pioneer in tryptase discovery and evaluation, points out that the comparison of acute tryptase concentrations with basal values 24 h afterword is more reliable than a single measurement at the time of the reaction. Indeed, several factors discussed by Sprung et al., as well as in our article, may be responsible for elevated basal tryptase concentrations. Mastocytosis, when severe, can be responsible for immediate hypersensitivity reaction but is rare and usually already diagnosed in patients referred to the operating room. This is also the case for acute myelocytic leukemia, myelodysplastic syndromes, hypereosinophilic syndrome, and therapy with recombinant stem cell factor. Finally, mildly increased tryptase concentrations have been reported in stages 4 and 5 chronic renal failure and in hemo-dialysis patients but not in stages 1 and 2.
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