Table 3.

Biomarkers for anaphylaxis

Biomarker	Secreted source	Advantage	Disadvantage
Serum/plasma/urine histamine [62]	Mast cells Basophils	Histamine can be useful for the evaluation of early-onset anaphylaxis	Insufficiency for evaluating anaphylaxis
Serum tryptase [25,26]	Mast cells Basophils	High specificity and more stable than histamines	Low sensitivity
		The gold standard for anaphylaxis diagnosis	Increases in some cases of adult healthy controls
			Limitations in food-allergy in children
Skin tests [25,26]	-	Useful for evaluation of penicillin allergy, food allergy	False positives: β-blockers and angiotensin-converting enzyme inhibitors
		A safe and non-invasive method for patients with a history of anaphylaxis and mastocytosis	False negatives: Hymenoptera hypersensitivity
			Monoclonal antibody: the specificity and sensitivity are not well-defined.
Specific serum IgE [25,26]	B cells	High sensitivity and specificity in Hymenoptera venom- specific IgE	Limitations in food allergies, penicillin allergy
		Evaluation of platins-specific IgE in the short-time
		Evaluation of cross-reactivity with drugs
Component-resolved diagnostics [63-65]	-	Prediction of allergic reaction severity	Lower sensitivity in food allergy
		Have greater specificity in food allergy	Expensive, labour intense
		Capable of detecting the causal agent
		A useful tool in Hymenoptera allergy
Basophil activation test [25,26,66]	Basophils	Easily assessed	Expensive, labour intense
		Useful diagnosis and management for β-lactams, muscle relaxants, Hymenoptera venom allergies, fish allergy
		A true reflection of sensitized mast cells
Others [25,26]	Serum PAF, serum TNF-α, IL-6, and IL-1β, Prostaglandin D2 and leukotrienes E4 and C4, chymase and carboxypeptidase, mast cell activation test

PAF, platelet-activating factor; TNF-α, tumour necrosis factor α; IL, interleukin.