NDLI: Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions.

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Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Stone, Shelley F. Cotterell, Claire Isbister, Geoffrey K. Holdgate, Anna Brown, Simon G. A.
Description	Country affiliation: Australia Author Affiliation: Stone SF ( Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Royal Perth Hospital and the University of Western Australia, Perth, Australia. Shelley.Stone@uwa.edu.au)
Abstract	BACKGROUND: Anaphylaxis is generally unanticipated and requires emergency management. Therefore, the biological mediators in human beings have been difficult to define. OBJECTIVE: Our aim was to identify cytokines and chemokines whose concentrations increase during anaphylaxis in human beings and to determine how each correlates with severity. METHODS: We measured the concentrations of potential mediators, including cytokines, chemokines, mast cell tryptase (MCT), and histamine, over 3 time points in 76 patients presenting to emergency departments with anaphylaxis and correlated these with a global severity scale, hypotension, and hypoxia. RESULTS: IL-2, IL-6, IL-10, TNF receptor I, MCT, and histamine were significantly elevated in patients with severe reactions (n = 36) compared with moderate reactions (n = 40) and healthy controls. Histamine levels peaked at emergency department arrival, whereas other mediators peaked later. IL-4, IL-5, IL-13, IFN-gamma, and TNF-alpha were marginally elevated in severe reactions compared with healthy controls but did not correlate with reaction severity. Severe reactions tended to be either hypotensive (n = 19) or hypoxemic (n = 12). Levels of IL-6, IL-10, TNF receptor I, MCT, and histamine correlated with hypotension. No mediator correlated with hypoxemia or other respiratory features. CONCLUSION: This study confirms that the concentrations of a number of cytokines are elevated in blood during anaphylaxis in human beings and that some correlate with the presence of hypotension. Others were only marginally elevated within a concentration range that available assays do not reliably detect. During respiratory reactions, mediators may be largely confined to the airways so that blood concentrations do not reflect activity.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
Journal	Journal of Allergy and Clinical Immunology
Issue Number	4
Volume Number	124
Language	English
Publisher	Elsevier
Publisher Date	2009-10-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Anaphylaxis Blood Immunology Cytokines Acute Disease Histamine Hypotension Prospective Studies Tryptases Multicenter Study Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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