Hi Rocky and welcome to the forum! Sometimes a major health event will bring a mast cell disorder out of hiding. Does anyone else in your family have anything like this?
Ana has pretty much said everything. Was the tryptase mature tryptase or tryptase within an hour of anaphylaxis? While 25 is not very high, it is a good marker for following the SM. If it stays around 25 or increases very slowly and your CBCs are normal, not having many symptoms, then you probably are in the indolent category. In that case, progression would be unlikely. It's very rare anyway (under 5 % of patients progress). Have carcinoid syndrome and pheochromocytoma been ruled out? It's unlikely that you have either, but they should be tested, if they haven't. Some doctors do other annual testing. There are some posts here that talk about tests.
You should have a bone density test, and I think that's every other year. SM can cause bone loss, and you don't want to wait until you have a broken bone to find out. Since it's not typically done on men, you might have to ask for it. Bone loss from osteoporosis can be reversed with weight-bearing exercise and calcium supplements and, if needed, medicine.
The doctor might want you to also do a bone survey (a set of x-rays) to assess other aspects of possible bone changes. My doctor also has ordered a chest and abdominal CT to look for organ enlargement, but you may have already had that.
Were you checked for the C-kit mutation? That's potentially important if at some time your symptoms were worse, as it would dictate which kind of treatment would be helpful.
Do you mind sharing the name of the doctor in St. Louis (Wash. U.) who diagnosed your SM and what his or her specialty is? There are others in that area who are looking for a doctor for testing and follow-up. I grew up in the St. Louis area. I like going back there.
It would be a good idea to look at the emergency protocols posted on this website and at
www.tmsforacure. Should you ever need another medical procedure, you ought to know about pre-medicating for it. We are advised to take antihistamines and prednisone before any procedure to avoid any reactions/anaphylaxis during a surgery, etc. This is very important in order to be safe. It's always critical to talk personally to any anesthesiologist, too, before a procedure to ensure he/she knows what medicines should be avoided and which are less likely to cause problems. There's a list in the emergency protocols that is a guide for your doctors.
Another list to look at is the one that lists many different meds and which are safer for mast cell disorder patients. The ICUS website has a version of a low histamine diet that might be helpful in sorting out what triggers your symptoms.