There was a time when I ordered mast cell testing frequently — serum tryptase, plasma histamine, 24-hour urine mediators. Over time, I’ve stepped back. Not because mast cell activation isn’t real — but because many of these tests lack sensitivity, fluctuate significantly, and often don’t change what I’m going to do clinically. If someone has episodic, multi-system flares — flushing, GI symptoms, brain fog, tachycardia — especially in the context of hypermobility and dysautonomia, and I can’t oth

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