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Mast cells are effector cells of the immune system and perform various functions at the physiological level and in the pathogenesis of diseases. They are responsible for immediate allergic reactions by releasing substances called "mediators," which they store or produce.
Mast cells are effector cells of the immune system and perform various functions at the physiological level and in the pathogenesis of diseases. They are responsible for immediate allergic reactions by releasing substances called "mediators," which they store or produce. When a person has an allergic reaction, the release of mediators produces the IgE antibody, which binds to the proteins that cause allergies and triggers degranulation. This process generates the visible symptoms of allergies that affect different parts of the body:
The release of mediators in mast cells can be gradual or rapid, depending on the allergen to which the body was exposed.
Mast cells can also be activated by medications, infections, or insect or reptile venom proteins. This response is known as secondary activation, as it is due to external stimuli. Although undesirable, it is a normal response.
Sometimes, mast cells become defective and release mediators in situations where there are no allergens and other substances to activate them. Abnormal signals from the body usually trigger their activation. The hyperreaction of mast cells when there is a normal amount in the body is known as Mast Cell Activation Syndrome (MCAS).
Patients with this condition repeatedly experience the symptoms of an allergic reaction without any exposure to an allergen. During these episodes, mast cells release high levels of mediators, causing anaphylaxis, hives, inflammation, low blood pressure, difficulty breathing, severe diarrhea, or other severe allergic symptoms.
The episodes of MCAS are idiopathic, as the activation mechanism is unknown. In other words, allergic antibodies or obvious secondary factors do not cause them, and treatments with mast cell mediator inhibitors typically resolve them.
Mast cells are a common and necessary cell in the body and originate in the bone marrow, from where they migrate to other tissues. In about one in two thousand people, mast cell production is high or defective. The abnormal increase of mast cells in various parts of the body is known as mastocytosis. It is not a single disease but a group of diseases that can affect one or several organs; it mainly presents on the skin.
Mastocytosis causes itching, facial redness, general malaise, blisters, abdominal pain, diarrhea, difficulty concentrating, malabsorption, osteoporosis, anaphylaxis, among other problems; all of these are common symptoms of allergies.
The difference with MCAS is that in mastocytosis, there is an uncontrolled increase in mast cells, which causes an excessive release of mediators. In MCAS, the body's abnormal signals activate mast cells, which are within normal ranges.
Symptoms of Mast Cell Activation Syndrome (MCAS)
At first, people may confuse the symptoms of this syndrome with exposure to allergens or anaphylaxis because they resemble allergic reactions. However, if the symptoms occur regularly or in controlled environments without allergens present, it is a sign of MCAS.
The symptoms affect different systems of the body. While they usually manifest in a specific organ consistently, they can affect other systems. The most common signs are:
The test to determine if the patient suffers from MCAS begins by determining if the symptoms are not caused by allergens and occur in separate attacks. Sometimes, the typical symptoms of an anaphylactic reaction occur constantly during certain seasons, but if there is no apparent cause, it is necessary to consult a specialized medical team.
Once the doctor has detected that the symptoms are atypical, a measurement of mast cell mediators is necessary. The doctor performs this test during an acute episode of symptoms. If the mast cell level falls within normal ranges and the meters spike, we can choose to treat with mast cell mediator inhibitors. If there is an improvement, the diagnosis is complete.
After confirming the diagnosis of MCAS, the specific case should be classified based on its cause.
We have identified three general types of MCAS through various tests and studies, classifying them according to their causes and the organs they affect.
It occurs as a result of the proliferation of monoclonal mast cells; that is, the mast cells clone themselves and accumulate in the tissues of certain organs. These mast cells usually present a KIT mutation, CD25+. Most cases of primary MCAS manifest with cutaneous or systemic mastocytosis, with symptoms including skin rashes, hives, abdominal pain, and anaphylaxis.
In this case, the mast cells are hyperactive. They do not clone themselves abnormally, but they react quickly to any type of external activation. It presents symptoms similar to allergies, in addition to increasing the symptoms of allergic reactions to nuts, shellfish, pollen, food, and alcohol.
The patient meets the criteria for MCAS, but there is no relationship with a reactive disease, IgE-dependent allergy, or clonal or neoplastic mast cell activation. Patients experience symptoms similar to those of an allergy, but they are not allergic to anything.
In diagnostic management, especially in cases of severe symptoms such as anaphylaxis, it is essential to identify patients based on genetic mutation parameters.
After diagnosing MCAS, patients typically experience high effectiveness and relief from the treatment. In case there is no relief with the treatment, we are not dealing with a case of MCAS, but it could be mastocytosis or another inflammatory condition, such as CIRS.
Antihistamines, such as first-generation H1 blockers, are the most common treatments, but side effects like drowsiness often limit their use. Second-generation antihistamines are becoming a more popular choice due to their reduced side effects, albeit with careful use.
H2 blockers can also be chosen to control abdominal pain and nausea. Acetylsalicylic acid is used to block the production of prostaglandin D2 and can reduce skin redness. Only use corticosteroids as a last resort for cases of edema, hives, and wheezing.
When dealing with acute episodes, it's important to adhere to common anaphylaxis treatment recommendations until the patient stabilizes and other treatments can resume.
Histamine intolerance is a condition caused by the inability to digest this molecule. The body naturally produces histamine, which is also present in some foods. If the body cannot break down histamine, it accumulates in the body, causing allergy-like symptoms.
If someone who is allergic to histamine also has MCAS, they need a full treatment plan that includes the right medicine, changes to their diet that limit foods that are high in histamine, and extra care with allergens.
Mast cells generate histamine in an allergic reaction, and when suffering from MCAS, the levels can rise in such a way that the symptoms are exacerbated, mainly:
Because the symptoms of MCAS and histamine intolerance are similar, it will be hard to tell the difference between the two. This is why you need a treatment plan that addresses the symptoms, stops allergic reactions, and naturally lowers histamine levels.
While a person with MCAS will not necessarily develop histamine intolerance, they do have a higher risk due to constantly high levels caused by the hyperactivity and hyperreaction of mast cells. Therefore, it is necessary to receive appropriate treatment promptly and consult a doctor to obtain an accurate diagnosis and a suitable treatment plan.
MCAS is a disease that requires constant treatment, lifestyle adjustments, and ongoing medical monitoring to avoid acute episodes. If the recommended treatment is followed, the quality of life will greatly improve.
There are ways you can manage MCAS. Learn the early warning signs of a reaction. See your doctor as soon as possible if you feel that the treatment is not managing your symptoms.
At Mitogenesis Regenerative Medicine, we can find a comprehensive strategy that can transform your life, alleviate inflammatory processes, and detoxify the body to improve overall well-being and quality of life.
If you wish to contact Dr. Mel Schottenstein at Mitogenesis or learn more about the treatments we offer, please call us or fill out a contact form with your information!
Sources:
Mast Cell Activation Syndrome (MCAS) (https://www.aaaai.org/conditions-treatments/related-conditions/mcas)
Mast Cell Activation Syndrome (https://my.clevelandclinic.org/health/diseases/mast-cell-activation-syndrome)
What Is Mast Cell Activation Syndrome? (https://www.webmd.com/allergies/what-is-mast-cell-activation-syndrome)
Mast cell activation syndrome: a review (DOI: 10.1007/s11882-012-0322-z)
Histamine Intolerance: The Current State of the Art (DOI: 10.3390/biom10081181)
Reviewed by:
Dr. Mel Schottenstein
Naturopathic Doctor
NMD, MBE, MScN, FICT, FSCT
Disclaimer: The information in this article is provided for informational purposes only and is not a substitute for the advice of your physician or other health care professional. Do not use the information to diagnose or treat a health problem or disease. Always consult with a healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem.
