Serum MRGPRX2 as a Long-term Biomarker for Iodinated Contrast Media-Induced Anaphylaxis

Abstract

The diagnosis of anaphylaxis is based on the clinical history. The utility of tryptase measurements in clinical setting is limited. Mas-related G protein-coupled receptor-X2 (MRGPRX2) is expressed in mast cells and is involved in the degranulation of these cells. We evaluated the potential of MRGPRX2 as a diagnostic biomarker in patients with iodinated contrast media (ICM)-induced immediate hypersensitivity reactions (IHRs). A total of 173 patients with documented ICM-induced IHR within 4 months from registration were enrolled and skin tests for the culprit ICM were performed. The time interval was evaluated as the duration between the onset of ICM-induced IHR and the measurement of serum MRGPRX2 levels. Serum MRGPRX2 concentration was determined using an enzyme-linked immunosorbent assay kit. Of the 173 patients, 33 and 140 were included in the anaphylaxis and non-anaphylaxis groups, respectively. Serum MRGPRX2 levels were significantly higher in the anaphylaxis than in the non-anaphylaxis group (29.9 ± 24.1 vs. 20.7±17.5, P = 0.044). Serum MRGPRX2 showed a moderate predictive ability for anaphylaxis, with an area under the curve of 0.61 (P = 0.058). When groups were classified based on the time interval, T1(0-2months) and T2 (2-4months), patients with anaphylaxis had higher MRGPRX2 levels compared to the non-anaphylaxis group in the T2 group (36.5±19.2 vs. 20.5±19.0, P = 0.035). This pilot study shows that serum MRGPRX2 is a potential long-term biomarker for predicting anaphylaxis, particularly ICM-induced anaphylaxis. Further studies are needed to determine the role of MRGPRX2 in anaphylaxis in a larger population of patients with various drug-induced IHRs.

Keywords: Hypersensitivity; anaphylaxis; drug; tryptase.

Fig. 1. Definition of time interval. The time interval was defined as the duration between ICM-induced IHR occurrence and serum MRGPRX2 level measurement at registration.

ICM, iodinated contrast media; IHR, immediate hypersensitivity reaction; MRGPRX2, Mas-related G protein-coupled receptor-X2.

Fig. 2. Differences in serum MRGPRX2 levels related to anaphylaxis. (A) Serum MRGPRX2 levels were significantly higher in the anaphylaxis group than in the non-anaphylaxis group (29.9 ± 24.1 vs. 20.7 ± 17.5, P = 0.044). (B) The AUC of serum MRGPRX2 for predicting anaphylaxis was 0.61 (P = 0.058) and the cut-off value was 22.3 ng/mL.

MRGPRX2, Mas-related G protein-coupled receptor-X2; AUC, area under the curve.

Fig. 3. Differences in serum MRGPRX2 levels related to time intervals. The T1 group comprised patients who had a time interval of 0–2 months, and the T2 group comprised patients who had a time interval of 2–4 months. Patients with anaphylaxis had significantly higher MRGPRX2 levels than those in the non-anaphylaxis group in T2 (36.53 ± 19.19 vs. 20.45 ± 18.98, P = 0.035).

MRGPRX2, Mas-related G protein-coupled receptor-X2.