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Factors that predict disease severity in atopic dermatitis: The role of serum basal tryptase

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Increased numbers of mast cells that contain tryptase are found in lesional atopic dermatitis (AD) skin. The association of serum basal tryptase (sBT) with anaphylactic reactions and mast cell diseases has recently been shown in children with venom and food allergy.


We aimed to identify the risk factors that predict the severity of AD and the association of sBT levels with AD and disease severity.


AD diagnosis was made according to Hanifin and Rajka criteria. Disease severity was scored by the objective scoring atopic dermatitis (SCORAD) index. The sBT levels were measured. Skin-prick testing, total immunoglobulin E, eosinophil percentages and counts, and a questionnaire concerning the history of atopic diseases and the risk factors of AD were applied.


The children, ages 0.5 to 3.0 years, with AD (n = 85) were analyzed in two groups according to the presence (AD+/atopy+ [n = 55]) or absence (AD+/atopy− [n = 30]) of skin-prick test positivity. The comparisons were made with an age- and sex-matched control group (n = 82). The median (interquartile range) sBT in the AD+/atopy+, AD+/atopy−, and control groups were 5.01 ng/mL (2.75‐6.79 ng/mL), 3.02 ng/mL (1.67‐4.44 ng/mL), and 2.63 ng/mL (1.31‐4.49 ng/mL), respectively (p = 0.003). The median (interquartile range) sBT levels were higher in patients with moderate-severe objective SCORAD index scores compared with the those with mild disease (3.85 ng/mL [2.04‐5.91 ng/mL] versus 2.80 ng/mL [1.83‐3.48 ng/mL]; p = 0.038). Multivariate logistic regression analysis showed that an sBT level of ≥3.9 ng/mL (odds ratio 8.77 [95% confidence interval, 1.87‐41.18]; p = 0.006) was independently associated with an increased risk of moderate-severe AD (objective SCORAD index).


To our knowledge, this was the first study that indicated that sBT levels may be important in the AD disease process and associated with the disease severity and atopy.
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Keywords: Atopic dermatitis; atopy; children; cutoff level; disease severity; logistic regression; mast cell; objective SCORAD; skin disease; tryptase

Document Type: Research Article

Affiliations: 1: From the Department of Pediatric Allergy and Immunology, Kayseri Education and Research Hospital, Erkilet Kayseri, Turkey 2: Division of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey 3: Department of Dermatology, Kayseri Education and Research Hospital, Erkilet Kayseri, Turkey 4: Department of Pediatrics, Kayseri Education and Research Hospital, Erkilet Kayseri, Turkey

Publication date: September 1, 2018

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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