Approach to Elevated Tryptase - Differential Diagnosis Framework The DDx of elevated tryptase can be broken down into a 4-pass system: 1st pass = Dangerous secondary causes: • Anaphylaxis • Angioedema 2nd pass = Chronic & Rx-related Secondary causes: • Rx-related: opioids, NSAIDs/Aspirin, IV contrast • CKD/ESRD & CAD • Eosinophilic GI Disorders • Parasitic infections • Chronic Urticaria 3rd pass = Primary Causes: • Mast cell activation syndrome • Mastocytosis • Other hematologic malignancy 4th pass = Genetic Causes: • Familial hypertryptasemia: Andrew Sanchez M.D. @ASanchez_PS #Tryptase #Differential #Diagnosis #hematology #allergy
