Tryptase levels in children presenting with anaphylaxis to the Montreal Children’s Hospital
Bibliographic record
Abstract
Children presenting with anaphylaxis to the Montreal Children’s Hospital Emergency Department (ED) between April 2011 and April 2013 were recruited. The treating physician documented symptoms, triggers, and management of the anaphylactic reactions. Total tryptase levels were measured 30-120 minutes following onset of symptoms. Charts of all ED patients were reviewed to identify cases that were missed in prospective recruitment. Multivariate logistic regression was used to examine the association between an elevated tryptase level and age, gender, reaction trigger, reaction severity, and history of atopy. Of 398 anaphylaxis cases (203 of whom were recruited prospectively), 84 children had serum tryptase levels measured. Age, gender, anaphylactic trigger, and severity of reaction were comparable between cases with and without tryptase measurements. However, there was higher percentage of patients treated with epinephrine in hospital in the group with tryptase measurements. The median age of these 84 children was 5.1 years (IQR 1.3, 12.3), 40.4% were females, 78.6% identified food as the potential anaphylactic trigger, and 7.1% experienced a severe reaction.. The mean tryptase level was 6.9 ng/mL (4.5, 8.0). Only 13 patients [15.5% (95%CI, 8.8,25.4)] had elevated levels. Severe reactions and history of eczema were associated with elevated levels ( OR =115.4 (95%CI,8.7,1527.8) and 14.2(95%CI,2.6,78.5) respectively. Our results do not support the use of total tryptase as a diagnostic tool in children with anaphylaxis. Given the poor sensitivity (13/84 = 15%) of the current tryptase threshold, new laboratory tests need to be developed to help establish the diagnose of anaphylaxis accurately. Severe reactions and presence of eczema are associated with high levels, but wide confidence intervals preclude definitive conclusions for the other risk factors we investigated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".