Do you perform a bone marrow biopsy in all patients with grade 5 anaphylaxis to stinging insects and negative workup for HAT, MCAS, c-KIT?

Before saying that bone marrow biopsy is the next step (which it is), we must be certain that we are correctly assessing the situation. Was there documented hypotensive shock (and not just subjective light-headedness or brief vasovagal syncope? Were there other objective signs like urticaria (although less common in patients with mastocytosis), or respiratory compromise and/or hypoxemia (not just subjective dyspnea or VCD)? Even if baseline serum tryptase is normal, patients with anaphylactic shock after a sting often have more subtle forms of mastocytosis (bone marrow mastocytosis-BMM, or monoclonal mast cell activation syndrome-MMAS). Was the blood c-kit measured by high-sensitivity PCR assay (not the usual assay ordered by hematologists)...