In Vitro Diagnosis of Anaphylaxis: an Update

Purpose of reviewThe management of anaphylaxis, after a rapid clinical-based hypothesis and prompt treatment introduction, includes diagnosis confirmation. We reviewed main laboratory methods available for diagnosing anaphylaxis and its etiology. Then, we searched for new methods that can gain utility in the next few years.Recent findingsSerum tryptase is still the most accurate and available method for diagnosis during the acute phase, although it is necessary to measure baseline levels after a period of time. However, measurement of other mediators, such as histamine and lipid metabolites, is available in many sites with good accuracy. For etiologic diagnosis, serum-specific IgE, component-resolved diagnosis (CRD), and basophil activation test (BAT) are available and sometimes helpful, and the new mast cell activation test (MAT) has been recently proposed to help confirming activation of those cells by a specific trigger.SummaryIn vitro tests can help clinicians to confirm anaphylaxis diagnosis and sometimes its etiology, but many triggers cannot be confirmed by laboratory methods. Then, allergist consultation after an anaphylactic reaction is mandatory to order the most appropriate tests and, if indicated, to perform in vivo tests.