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The diagnosis is made on clinical grounds and should be considered if the patient develops:

 Unexplained hypotension or bronchospasm

 Unexplained tachycardia or bradycardia

 Angioedema (often absent in severe cases)

 Unexplained cardiac arrest where other causes are excluded

 Cutaneous flushing in association with one or more of the above signs (often absent in severe cases)