8
Diagnosis
Table 5. Tests Useful in Establishing a Diagnosis of
Anaphylaxis, a Condition Mimicking Anaphylaxis, or
Establishing the Causal Event
Establishing anaphylaxis as a cause
• During an event obtain:
▶ Serum tryptase
▶ Plasma histamine
▶ 24-h urinary histamine metabolites
▶ Urinary prostaglandin D
2
Using the laboratory to establish a diagnosis of a condition mimicking anaphylaxis
• Serum serotonin
• Urinary 5-hydroxyindoleacetic acid
• Chromogranin A
• Vasointestinal polypeptide
▶ Substance P, vasointestinal polypeptide hormone, urokinase A, pancreastatin, etc.
▶ Computed tomography, magnetic resonance imaging, single-photon emission
computed tomography (octreotide or pentetreotide assisted)
• 24-h urinary catecholamines
• Serum catechols
• Plasma free metanephrine
Tests to establish the etiology of anaphylactic events
• Skin tests to foods to drugs when indicated
▶ Skin tests using standard commercially available extracts
▶ Skin tests using fresh food
• Serum-specific IgE to foods and drugs when indicated
• Oral challenge
• Galactose-1,3-a-galactose
• Baseline serum tryptase
• Baseline 24-h urinary histamine metabolites
• Prostaglandin D
2
• Blood determination for KIT-D816V mutation
• Bone marrow
