Anaphylaxis and Clinical Utility of Real-World Measurement of Acute Serum Tryptase in UK Emergency Departments Richard J. Buka, MBChB, Rebecca C. Knibb,

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Anaphylaxis and Clinical Utility of Real-World Measurement of Acute Serum Tryptase in UK Emergency Departments Richard J. Buka, MBChB, Rebecca C. Knibb, PhD, Richard J. Crossman, PhD, Cathryn L. Melchior, RN, Aarnoud P. Huissoon, PhD, FRCP, Scott Hackett, MD, FRCPCH, Susan Dorrian, FRCP, Matthew W. Cooke, PhD, FRCS, Mamidipudi T. Krishna, PhD, FRCP The Journal of Allergy and Clinical Immunology: In Practice Volume 5, Issue 5, Pages 1280-1287.e2 (September 2017) DOI: 10.1016/j.jaip.2017.06.021 Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 Study algorithm. A total of 3516 attendances to the ED during 2012 were identified using an electronic search of the attendances database using wide search terms. A total of 426 attendances fulfilled the WAO diagnostic criteria for anaphylaxis. A total of 141 patients had a measurement of acute serum tryptase, and 23 of these had a baseline tryptase measurement. Seventy-six were followed up in the allergy clinic. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1280-1287.e2DOI: (10.1016/j.jaip.2017.06.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 ROC curve showing acute serum tryptase level measurements in patients with anaphylaxis vs control group (patients not fulfilling the WAO diagnostic criteria for anaphylaxis) (area, 0.58; 95% CI, 0.47-0.69; P = .19). Table III shows sensitivity, specificity, NPV, and PPV for acute serum tryptase at different cutoffs. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1280-1287.e2DOI: (10.1016/j.jaip.2017.06.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E1 Correlation between acute serum tryptase level measurement and time from symptom onset to sampling. There is a weak negative correlation between acute serum tryptase level and time between symptom onset and sampling. Pearson correlation coefficient −0.19 (P = .026). N = 132 (9 did not have recorded timings). The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1280-1287.e2DOI: (10.1016/j.jaip.2017.06.021) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions