If I have anaphylactic episodes, with flushing, diarrhea & low blood pressure, could I have carcinoid syndrome?

I can provide some general suggestions that should be useful, as regulations restrict me from answering specific questions. Carcinoid crisis is characterized by abrupt flushing of face and sometimes upper body, usually severe fall in blood pressure and even bronchospasm with wheezing can (infrequently) occur. The attack may look like an anaphylactic attack. Diarrhea is an important part of carcinoid syndrome but is not usually simultaneous with the carcinoid crisis. It more commonly occurs as part of the anaphylactic reaction or an allergic or pseudoallergic reaction.

Standard allergy tests are not usually positive in such cases. 24 hour urine histamine, blood histamine and blood tryptase tests, particularly if obtained at the time of attack or just afterwards will establish diagnosis of allergic or pseudo allergic so called idiopathic anaphylactic attacks and mast cell disease. Epinephrine will provoke – not help – carcinoid attacks. Urine 5HIAA is helpful when positive but if depended on as the sole chemical test for carcinoid syndrome will miss 50% of cases! Better also to measure blood serotonin, tryptophan and chromogranin A.

Other blood markers associated with rare cases of severe attacks of flushing, diarrhea and fall in blood pressure are VIP, calcitonin and gastrin. They too should be measured. If any of all of the above are positive – as I expect may occur – further elaborate tests and treatment will be needed with details depending on which test(s) are positive. You should consult an expert for this if and when you arrive at this stage.

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