By Albert S. Hartel, M.D.
Mast cell activation syndrome is an underdiagnosed and often missed condition that can cause a variety of unexplained symptoms, but awareness is growing.
Symptoms include a wide variety of combinations of nausea, abdominal pain or cramping, diarrhea, fatigue, weakness, brain fog, skin itching, flushing, swelling, nasal and sinus symptoms, joint pain, cough, wheeze and even low blood pressure, racing heart rate or anaphylaxis.
Not all symptoms are present in each individual and can come and go without explanation.
The human body contains billions of allergy-immune cells called mast cells. In most people the mast cells sit inactive unless activated by specific allergic triggers that release a mild to massive amount of chemicals that can have profound effects on the body.
Mast cell activation syndrome is a condition where the mast cells become much less stable and release chemicals much easier, often in response to only limited stimuli that wouldn’t otherwise cause chemical release.
Unlike classic allergic reactions, symptoms often occur without an apparent trigger and can be much more frequent. The syndrome can be tricky to diagnose. Even though histamine is one of the major chemicals causing symptoms, testing histamine in blood is not reliable and can miss the diagnosis. Diagnosis includes a detailed history, testing to identify triggers, as well as a blood test, often followed by a urine collection looking for specific chemicals produced during mast cell release.
There is an extensive list of triggers including infections, overheating, stress-anxiety, alcohol, ibuprofen/NSAIDS, hormones, weather changes and histamine containing foods such as yeast, fermented foods, strawberries, and dyes, as well as many others.
The effects of anything that causes chemical release is cumulative and often baseline triggers can make someone much more susceptible to tip over easily and have more frequent or more severe symptoms.
The largest trigger is often allergens, and severe allergies can very closely mimic many of the symptoms of mast cell activation syndrome. Allergy skin testing to identify and avoid all allergic environmental and food triggers is critical to reduce total cumulative chemical effects and minimize symptoms.
Treatment includes avoiding and reducing triggers and exposures, dietary modifications, a combination of antihistamine medications, as well as mast cell stabilizers, environmental measures, epinephrine injectors, and often allergy shots to further minimize total mast cell chemical release. Other medications are available for severe cases. With proper diagnosis and treatment by an Allergist it is possible to gain control of symptoms and significantly improve quality of life!
Physician Albert S. Hartel specializes in pediatric and adult allergy and immunology. He is the president of Allergy Asthma Immunology of Rochester. For more information, visit https://aair.info or call 585-442-0150.