Abstract
Baseline serum tryptase should be drawn in all patients with severe insect sting anaphylaxis, especially in those with hypotension and without urticaria. Elevated levels help identify patients with mastocytosis, using REMA scores to guide the need for bone marrow biopsy. Even without mastocytosis, elevated baseline serum tryptase is a risk factor for anaphylaxis to field stings and for reactions during desensitization itself.
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