Dec
17
2022

Mast Cell Activation Syndrome

Mast cell activation syndrome (MCAS) also goes by the name of systemic macrocytosis. That is to say it is a syndrome where mast cells are multiplying abundantly and secreting the inflammatory substances histamine, leukotrienes and cytokines. Certainly, people who suffer from MCAS can get severe anaphylactic reactions, but an epinephrine injection can often stop this.  Indeed, the physician must look for potential triggering factors like alcohol, spicy foods, exercise, insect stings, possible heavy metal accumulation or certain medications. In some cases heavy metal accumulation could also be a factor that triggers mast cells to release histamine.  In these cases a series of 20 chelation therapy sessions would be stabilizing.

Symptoms of mast cell activation syndrome

  • When there is skin involvement in patients with mast cell activation syndrome, they get flushing, itching and skin rashes.
  • With gastrointestinal involvement patients experience nausea and vomiting, bloating, abdominal pain, diarrhea and reflux (GERD).
  • Patients with neurological symptoms develop brain fog, headaches, cognitive problems, tremors and anxiety/depression.
  • When MCAS affects your endocrine glands, you may develop bone pain, bone lesions or weak bones.
  • Patients where the heart is affected may be fainting, their blood pressure may fluctuate between with high or low readings and they may experience heart palpitations.
  • When your respiratory system is affected, your lungs may be wheezing and you may develop nasal congestion.
  • More symptoms
  • The most dangerous symptom is anaphylaxis. This is a life-threatening allergic reaction where your air way entry could close off.
  • Any of these symptoms can get triggered by heat, cold or temperature changes. Stress, friction, insect bites or stings can also trigger a reaction. Additional factors can be environmental odors or perfumes, certain foods or medicine, alcohol and contrast dyes.

Diagnosis of mast cell activation syndrome

The most appropriate specialist to see is an allergist or immunologist. Other specialists could be a dermatologist, gastroenterologist, hematologist or endocrinologist. You will need blood tests like a serum tryptase level, which is a marker for mast cell burden. It is best to get a baseline tryptase level and also get a tryptase level after a mast cell reaction. In addition, you need a 24-hour urine collection for a number of mast cell activators. Depending on where your mast cell activation syndrome is located you need a skin or bone marrow biopsy.

More possible tests

The physician may decide to do an endoscopy or colonoscopy of the gastrointestinal tract. The pathologist can do several staining procedures with biopsy material to specifically look at mast cells. If there is a strong family history of mast cell activation syndrome the physician may decide to do genetic tests. In order to assess mast cell damage, your doctor may order a bone density test and bone scans including CT scans of the abdomen and chest.

Treatment of mast cell activation syndrome

The treatment of mast cell activation syndrome consists of a combination of multiple steps. First, if there is a life-threatening anaphylactic reaction, the patient applies an epinephrine injection. The physician taught the patient earlier how to do an epinephrine injection. This stops the sudden, rapid release of mediators from mast cells. After the epinephrine injection the patient needs transport to the nearest ER of a hospital for follow-up care. It is important that any patient with this syndrome should carry injectable epinephrine( an Epi-Pen) at all times.The purpose of treatment against mast cell activation syndrome is to block reactivity of mast cells or to stop the effects of mast cell mediators.

A number of medications are available to do this.

You can lower your risk of getting mast cell activation syndrome by watching your diet. Here is a list of the foods that will protect you:

Mast Cell Activation Syndrome

Mast Cell Activation Syndrome

Conclusion

Mast cell activation syndrome is a complex disease entity. Often there are several factors that contribute to this. Conventional medicine still cannot offer a treatment modality that will cure this condition, the only possibility is to control it. The physician must therefore use a combination of treatment modalities in order to help the patient with this condition. In cases of heavy metal accumulation several treatments with chelation therapy are beneficial. With an acute anaphylactic reaction, the

Mast Cell Activation Syndrome applies an epinephrine injection, which will stabilize the condition. But the patient should now follow this up with a series of blood tests in the emergency department of a hospital.

Treating mast cell hyperactivity

The purpose of treating mast cell activation syndrome is to block reactivity of mast cells or to stop the effects of mast cell mediators. H1 and H2 antihistamines help for gastrointestinal hyperactivity. Cromolyn sodium and ketotifen are mast cell stabilizers. Leukotriene inhibitors such as montelukast help to stabilize the mast cells to not secrete cytokines, which cause inflammation. Aggressive mast cell disease may require chemotherapy treatment, similar to what is needed to treat cancer.

The purpose of treatment is to help the patient control the mast cell hyperactivity. At this time medical science does not have all the answers. Unfortunately, at this point conventional medicine has no cure for this syndrome, but it can be managed with a lot of attention to the symptoms.

Apr
14
2013

Allergies Not Only In Spring

This article is about “allergies not only in spring”. Springtime is the time of spring allergies: those affected develop a runny nose, itchy eyes and in more severe cases they may experience a flare-up of asthma. Allergies can be triggered by the increase of pollen counts in the air that occurs every spring. In those who are sensitive, this leads to antibody formation in the blood. But often people have not only sensitivities to the pollens of spring bloomers; they may also be allergic to spores from molds, to dust mites and may have underlying allergies to foods.

Memory cells of the immune system

The immune system has memory cells that memorize that a person has had an allergic encounter to one of these items in the past, and allergic reactions can become more significant with a future encounter. Allergies often get worse when a person has food sensitivities and there are cross reactions between pollens of trees or grasses that share surface protein regions with similar protein regions in foods.

Cross allergies

It is known that cross allergies are possible between birch pollen and apple, carrots or hazelnut. In its extreme form allergies due to antibodies, called IgE antibodies, can cause anaphylaxis. A person presensitized by inhaling birch pollen, after eating an apple, hazelnuts or a carrot can develop itching of the throat, swelling of the lips and very quickly deteriorate getting into an anaphylactic shock.

Other cross allergies exist between ragweed pollen, which is a powerful inhalant allergen and melons or bananas. Again there are specific IgE antibodies that are responsible for this immune reaction. In this case the ragweed allergy primes the immune system to produce IgE antibodies, which are experience potentiation by certain foods that share similar protein components as the ragweed pollen.

In the following I will deal with inhalant allergies separately from food allergies.

Inhalant allergies

Inhalant allergies are easier to diagnose and to treat than food allergies. Your doctor will likely refer you to an allergist when you have allergies that do not respond to treatment with intermittent over the counter antihistamines. Your symptoms may come on in the spring with itchy eyes and a runny nose. From year to year you find that you become more and more dependent on antihistamines and nose drops to unplug your nose. The allergist likely will do sensitivity tests, which consist of skin prick or scratch tests on the back or the forearms.

Allergy shots to stabilize allergies

In more serious allergies, where the patient has coughing and wheezing attacks following allergic reactions, the allergist may suggest to start intermittent allergy injections alongside the standard inhalation therapy for asthma. The allergist prescribes an allergy serum where the lab mixes ingredients based on all of the positive tests that led to a strongly positive skin reactions through allergy testing.

Allergy injections

Typically, the family doctor or his nurse will start the allergy injections initially in weekly intervals.  After reaching the  maintenance dose, there may be a modification to injections every 10 to 14 days.

The allergy injections stimulate the immune system to produce harmless competing antibodies, which counteract the disease producing allergic antibodies. In the process of desensitization shots the immune system will normalize, which means that the inflammatory response of the immune system settles down to normal.

This is not the end of the story with inhalant allergies. The allergist needs to retest the patient on a yearly basis. The immune system changes all the time as new allergies can develop and old ones may go away.

Retesting allergies and sublingual immunotherapy

Retesting is necessary to keep track of what is going on and to change the composition of the allergy serum. Those patients who are working together with the allergist can do very well, and often they gradually outgrow their allergies. Others may not be so lucky. They may have reactions to the allergy injections. In these cases avoidance of what causes the allergy may be the only solution to treat the allergies.

There is an alternative to allergy injections, which physicians in Europe use, namely a sublingual immunotherapy. Recently there has been a review of the literature for FDA approval that is needed for oral desensitization for ragweed, dust mites, grass pollen and cat dander. It will take some time before the FDA approval process will become a reality for sublingual desensitization in the US.

Allergies to pets

A special form of inhalant allergies are allergies to pets (mainly dogs and cats, but also allergies to petting zoo animals). The dander that the human comes in contact with is a protein from the animal hair. It causes hives when it touches the skin. This occurs as the dander penetrates through the skin and meets the local mast cells that release histamine. This in turn is responsible for the hive formation. Sneezing and even asthma can develop from inhaled protein particles that reach the lungs. Allergy injections for the treatment of animal dander allergies often do not help or make the allergies worse. The allergist usually recommends avoidance of animal contact as the solution, a recommendation, which the affected animal lover often does not appreciate.

Allergies Not Only In Spring

Allergies Not Only In Spring

Food allergies

Often we eat  some foods more frequently, because they are our favorites. This means that our gut lymphocytes that get in contact with these foods can start to react to one or more of the foods we ingest. At this time we may experience abdominal cramps, diarrhea, vomiting and a host of other possible symptoms.

The physician will tell the patient that testing for food allergies is a problem. Most of the usual skin tests employed for inhalant allergies do not reliably work in determining food allergies. The doctor will ask the patient or the mother of the child with food allergies to keep a food diary and keep track of the allergic symptoms in the diary as well. An elimination diet will have to be devised based on the information gathered in the diary as it becomes clear from that record which foods cause which symptoms. The foods causing allergic symptoms are subsequently eliminated. This is a cumbersome process, but it is the most reliable method of testing and treating food allergies.

RAST test

In the past there was a blood tests, called RAST test, which tested for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. Since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test.

Children often develop food allergies to egg, milk, wheat, nuts, peanuts and soy, which are food allergies with positive IgE tests. When they age, their immune system develops tolerance to many of these foods and they often outgrow these allergies.

Antibody tests for food allergies

Only a blood drop is necessary to test a panel of foods with IgG, IgM and IgE antibodies. A number of suppliers offer these tests.  However, the specificity, sensitivity and reliability can pose problems with regard to the interpretation of the results. Allergists often point out that a test may be a false positive when a person likes certain foods. IgG antibodies against this food show up despite the patient having no symptoms. Another specialist may interpret this to indicate that the body shows early sensitization to a certain food.  However, clinically it is not yet obvious. In other words, the sensitivity of the test is so high that it undermines the validity of the test. Recently a panel of international scientists reviewed the validity of these IgG based food intolerance tests and they found the tests not reliable.

Testing for food allergies

The immune responses to food allergies are complex as there are immediate type immune reactions and delayed type immune reactions. The physician investigates the immediate immune responses with the above mentioned ImmunoCAP Specific IgE test. The delayed immune responses can be measured using the ELISA test.

Other considerations about allergies

You see from this discussion that a patient with allergies needs a properly trained allergist who will do a comprehensive analysis involving a thorough history, examination, blood tests and immune tests.  The specialist interprets the test results, which requires his/her experience and clinical judgment.

Clearfield wheat

Since the 1970’s when Clearfield wheat was introduced around the world on a large scale, which has a much higher gliadin (gluten) content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased. Scientists registered a substantial increase in wheat gluten intolerance in the world population. Genetically modified foods like soy, corn, sugar beets, canola and more are a challenge for the immune system. This is particularly so  in sensitive humans. Physicians do not fully understand why this is so. We do know that some people can develop autoimmune diseases. This may be the reason that a host of diseases are much more common now than in the past. Common autoimmune diseases are MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis and others.

Epi-Pen, chronic inflammatory diseases

After food elimination for 2 to 12 months depending on the severity of the food allergy, your body may have eliminated the allergy to the food you have avoided, in other words your body built up tolerance. Before you expose yourself to any food that you used to be allergic to and that you want to re-test, it is best to have an EpiPen ready in case your allergy has not resolved. Caution is necessary with regard to foods that cause more severe allergies, e.g. shellfish or peanuts. These type of allergies may last life long. It is safer to avoid these foods that cause more severe allergies altogether.

Chronic inflammatory diseases

Allergic reactions of the immune system belong into the category of chronic inflammatory diseases. These are known to be the root of chronic diseases like asthma, arthritis, heart disease, high blood pressure and cancer. Be vigilant about allergies and get proper assessment and treatment by an allergist. You will prevent serious health problems including the above mentioned chronic diseases.

More on asthma, which is a chronic inflammatory lung condition, often associated with multiple environmental allergies: