Approach to Elevated Tryptase - Differential Diagnosis Framework



The DDx of elevated tryptase can be broken down into a 4-pass system:



1st pass = Dangerous secondary causes:

 • Anaphylaxis 

 • Angioedema 



2nd pass = Chronic & Rx-related Secondary causes:

 • Rx-related: opioids, NSAIDs/Aspirin, IV contrast

 • CKD/ESRD & CAD 

 • Eosinophilic GI Disorders

 • Parasitic infections

 • Chronic Urticaria



3rd pass = Primary Causes:

 • Mast cell activation syndrome 

 • Mastocytosis 

 • Other hematologic malignancy 



4th pass = Genetic Causes:

 • Familial hypertryptasemia:



Andrew Sanchez M.D. @ASanchez_PS



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