Tryptase

They are inflamed through a histamine pathway, which could be muscle activation or histamine disorders, or they could have autoimmunity.

And based on those three phenotypes, their history, but I also get some labs like Triptase antibodies, I will assign one of these three diets, anti-inflammatory, low histamine, or the autoimmune protocol, lectin-free, and I'll assign them a gazillion supplements.

And then on the third visit, we do mind-body, and we do de-stressing, how to exercise correctly.

And that's it.

It's called the 20 plus two rule for tryptase.

What happens in the event that tryptase is normal? Well, this is when things get controversial again.

But hey, why not talk about it in a friendly, peaceful environment? Tryptase is the best established marker we have.

But mast cells produce so many different types of mediators beside tryptase.

And so you can actually evaluate urinary markers like N-methylhistamine or leukotriene 4 or dopamine.

But you should be doing that after, of course, you've already ruled out other things.

You've already got your spirometry, you've checked a blood Triptase, you've done the appropriate allergy testing, you've done all your good allergy workup.

And then I also encourage folks, um, to strongly consider still sending maybe to, like, an ENT to, to get a baseline scope, just to make sure their anatomy is normal.

You're not missing something like subglottic stenosis or something like that.