Tryptase

Introduction

As a Nurse Practitioner practicing in Florida, I have observed an increasing interest in understanding the role of various biomarkers in diagnosing and managing health conditions. One such biomarker that has gained attention in the realm of functional medicine is tryptase (Tryptase). This enzyme, produced mainly by mast cells, serves as a crucial indicator in diagnosing conditions related to mast cell activation, such as Allergy, anaphylaxis, and mastocytosis. In this article, we will delve into the background of tryptase, its clinical implications, reference ranges, and factors that can influence its levels.

Background of Tryptase

Tryptase is a serine protease enzyme predominantly produced by mast cells, with smaller amounts from basophils. Mast cells are immune cells that release chemicals—including histamine and tryptase—during allergic reactions. Understanding tryptase levels is vital for diagnosing mast cell activation syndrome (MCAS) and related disorders.

Clinical Implications of Tryptase Levels

Elevated Tryptase Levels

• Anaphylaxis: Acute mast cell degranulation during anaphylaxis leads to a marked rise in tryptase, correlating with symptoms such as hypotension, rash, pruritus, and respiratory distress.
  
• Mastocytosis: In systemic mastocytosis, abnormal mast cell proliferation elevates baseline tryptase.
  
• Bone Marrow Disorders: Myeloproliferative and myelodysplastic syndromes can elevate tryptase due to increased mast cell activity.
  
• Renal Disease: Chronic kidney failure may increase tryptase from local mast cell–mediated inflammation.

   

Low Tryptase Levels

Low tryptase levels suggest a low risk of mast cell activation disorders and can help rule out conditions like anaphylaxis and mastocytosis when clinical suspicion is low.

Reference Ranges for Tryptase

• Standard Range: 0.00 – 11.00 µg/L
  
• Optimal Range: 0.00 – 8.00 µg/L
  
• Suspicious for Systemic Mastocytosis: > 15 µg/L
  
• Further Investigation Threshold: > 20 µg/L

   

Interfering Factors and Drug Associations

• Basal Variability: Gender, age, kidney function, and hereditary alpha-tryptasemia can influence basal tryptase.
  
• Medications: Drugs that induce mast cell degranulation or impair renal clearance can alter tryptase levels—review medication history when interpreting results.

   

Diagnostic Considerations

Accurate assessment requires measuring both basal and acute tryptase, using the 20 + 2 rule (an increase of ≥ 20% + 2 µg/L above baseline indicates significant mast cell activation). Genetic testing for hereditary alpha-tryptasemia is recommended when baseline tryptase is ≥ 8 µg/L to guide management and avoid unnecessary procedures.

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner integrates tryptase testing into a holistic allergy and mast cell care model. By combining advanced biomarker analysis with targeted nutritional support, gut microbiome optimization, and personalized therapies, this approach transcends symptom management to restore immune balance and enhance resilience. Contact us at 904-799-2531 or schedule online, and explore our IV therapy and regenerative medicine services for comprehensive support.

Further Reading

• Valent, P., Akin, C., & Hartmann, K. (2020). Tryptase: A practical guide for the physician. Allergy, 75(7), 1595-1605.
  https://pubmed.ncbi.nlm.nih.gov/32712042/

• Schwartz, L. B., et al. (2025). What the clinician should know when ordering a mast cell tryptase test. Journal of Allergy and Clinical Immunology: In Practice.
  https://pubmed.ncbi.nlm.nih.gov/40074077/

• Bonadonna, P., et al. (2020). Recommendations for the use of tryptase in the diagnosis of anaphylaxis and mast cell disorders. Clinical Chemistry and Laboratory Medicine, 58(3), 345-355.
  https://pubmed.ncbi.nlm.nih.gov/31994369/

• Lyons, J. J., et al. (2023). The normal range of baseline tryptase should be 1 to 15 ng/mL and covers healthy individuals with hereditary alpha-tryptasemia. Journal of Allergy and Clinical Immunology: In Practice, 11(10), 3010-3020.
  https://pmc.ncbi.nlm.nih.gov/articles/PMC11869997/