NEW CRITERIA FOR ANAPHYLAXIS DIAGNOSIS

Anaphylaxis is a systemic and potentially life-threatening reaction. Multiple diagnostic frameworks have been proposed and periodically revised to balance sensitivity and specificity in real-world care. Diagnostic criteria, each with its advantages and disadvantages, aids in the management of this disease and provides insight into the evaluation of patients with severe allergic reactions. Recent updates, most notably The World Allergy Organization (WAO) 2020 and the 2023 WAO/Brighton/Delphi consen-sus, have increased diagnostic flexibility and expanded recognition of presentations such as isolated airway/laryngeal or cardiovascular involvement after a likely exposure, and they clarify the role of se-vere gastrointestinal symptoms, particularly following non-food triggers. These criteria also emphasize time course nuances (e.g., delayed reactions such as alpha-gal syndrome) and allow diagnosis when exposure is known or likely, improving sensitivity without compromising specificity. We compare these updates with legacy the National Institute of Allergy and Infectious Diseases/ Food Allergy and Anaphylaxis Network (NIAID/FAAN) and European Academy of Allergy and Clinical Immunology (EAACI) constructs, highlighting scenarios prone to over- and under-diagnosis and offering bedside implications. Overall, the current criteria provide a more practical and reliable framework in clinical practice, representing a significant improvement in diagnostic and treatment procedures. Nevertheless, clinical approaches to diagnosing anaphylaxis remain limited, and there is a continued need for objec-tive biomarkers to improve diagnostic accuracy, particularly in special populations where diagnosis is challenging. Because diagnosis remains primarily clinical, objective tools, especially paired acute and baseline serum tryptase levels, should be used judiciously, acknowledging their limitations in food-triggered reactions and in children. Emerging approaches may refine risk stratification and the timeliness of recognition. Genetic testing, including assessment of TPSAB1 (tryptase alpha/beta 1) copy-number variants consistent with hereditary -tryptasemia, and exploration of biomarkers, are promising avenues. In parallel, artificial-intelligence and natural-language-processing tools trained on electronic health records can assist real-time case identification and documentation, while com-plementing rather than replacing clinical criteria. These advances, together with clearer diagnostic definitions, aim to reduce missed diagnoses and inappropriate treatment, improving outcomes across diverse care settings.