See a clinician experienced in allergy/immunology or mast cell disorders
Review symptoms and triggers with a detailed history
Check whether symptoms affect multiple organ systems
Measure serum tryptase during a flare and again at baseline
Compare acute and baseline tryptase for a significant rise
Test urinary mast cell mediators during or soon after symptoms
Consider 24-hour urine or spot urine testing for:
N-methylhistamine
Leukotriene E4
Prostaglandin D2 metabolites
Rule out other conditions with similar symptoms
Evaluate for allergic disease, anaphylaxis, hereditary alpha-tryptasemia, and other causes
Consider bone marrow or other specialized testing if systemic mastocytosis is suspected
Repeat testing if initial results are normal but suspicion remains high
Use symptom patterns plus laboratory findings to support diagnosis