Abstract
Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.
Highlights
Anaphylaxis is an unpredictable, severe and potentially life-threatening hypersensitivity reaction [1,2]
In a population-based multinational European study, from 28 cases of anaphylaxis in pregnancy in France, Belgium and Finland, serum tryptase was tested in 53.8%, levels being raised in 84.6% of cases, compared with 35 cases of anaphylaxis in pregnancy in UK in which serum tryptase was tested in 85.7%, with increased levels in 32% of cases [6]
Total serum tryptase still remains the best current biomarker to support the diagnosis of anaphylaxis, elevated levels were reported in amniotic fluid embolism (AFE), and there is a need for further evaluation of other biomarkers in these life-threatening conditions [84]
Summary
Anaphylaxis is an unpredictable, severe and potentially life-threatening hypersensitivity reaction [1,2]. Manifestations of anaphylaxis include skin and mucosal involvement (e.g., generalized urticaria, pruritus or flushing, swollen lips-tongue-uvula), respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor), gastrointestinal symptoms (e.g., severe crampy abdominal pain, repetitive vomiting), reduced blood pressure or associated symptoms of end-organ dysfunction (e.g., hypotonia/collapse, syncope, incontinence). Severe anaphylaxis may occur without typical findings as skin features or circulatory shock [2,8,9] Because it is a life-threatening condition for mothers with potential neurologic sequels for fetuses, anaphylaxis during pregnancy require timely management. Our objective is to present and highlight the usefulness of biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management
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