PHW Newsletter - Edition 16

A Word from Dr. Grady

MCAS: Mast Cell Activation Syndrome

Introduction to MCAS

Mast cell activation syndrome (MCAS) is a dysregulation of the immune system in response to significant stress, where what we normally think of as the allergy response becomes a pervasive inflammatory condition. Instead of typical allergy symptoms like nasal congestion or hives, MCAS can affect any body system, causing symptoms like chronic fatigue, brain fog, pelvic pain, nerve pain, low blood pressure, rapid heart rate, and anxiety.

MCAS is currently estimated to affect 17-19% of the population, increased significantly from the original estimate of only 1%. It is typically a great stressor or series of stressors that lead to this condition – mental/emotional stress, infections like COVID or SIBO, surgery, or toxic overload from heavy metals or mold.

Diagnosis

Diagnosis of MCAS is often difficult and is usually based upon clinical picture, ruling out other diagnoses, and response to treatment. Mast cells degranulate hundreds of different chemical mediators, and most have short half-lives and are unstable at room temperature. Most labs lack the tools needed to collect and maintain sample integrity. Due to this lack of clarity in diagnostic tools, we often establish the diagnosis based upon response to treatment.

Treatment

Treatment varies from person to person. The general approach is identifying triggers and avoiding them, plus using natural and pharmaceutical inhibitors of various inflammatory pathways. These include histamine blockers, leukotriene blockers, antioxidants, COX inhibitors, and other anti-inflammatory agents. Dietary interventions include avoiding inflammatory and histamine-containing foods, and increasing foods rich in antioxidants like buckwheat (containing rutin), onions (containing quercetin), and green tea.

Suspecting MCAS

It may be suspected when you experience an array of seemingly unrelated symptoms that come and go, such as rapid bloating after eating, headaches triggered by changing environments, intermittent pain during urination, and anxiety that appears spontaneously. Women of child-bearing age may be affected more often due to estrogen promoting mast cell degranulation. If you suspect MCAS, don’t hesitate to make an appointment with your provider to discuss your symptoms.