Recommendations for the use of tryptase in the diagnosis of anaphylaxis and mastocytosis

Tryptase is a serine protease produced by mast cells and released into the circulation after IgE-mediated or non-IgE-mediated stimuli. Its dosage is therefore of great utility in the diagnosis of anaphylaxis and of mastocytosis. In this review, we describe the various aspects related to the molecular characteristics of tryptase and its biological effects, the genetic basis of its production and the release kinetics. Recommendations are also given on the best procedure for a correct definition of the reference values in relation to the inter-individual variability and to the correct determination of tryptase in blood and other biological liquids, in the diagnosis of anaphylaxis (from drugs, food or insect bites), death from anaphylaxis (post-mortem assessment) and cutaneous or systemic mastocytosis and mast cell activation syndrome.