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Diagnostic Criteria (Adapted from consensus guidelines): Chronic multisystem symptoms consistent with mast cell activation Evidence of elevated mast cell mediators (during flare or baseline), such as: Serum tryptase Plasma histamine Chromogranin A Urinary N-methylhistamine Urinary prostaglandin D2 or F2 Improvement with medications that block mast cell activity (e.g., antihistamines, cromolyn sodium) Testing is most accurate when done during or soon after a flare , and samples often need to be chilled and analyzed at specialized labs