Your symptoms could mean more, let’s take a look into Mast Cell Activation Syndrome (MCAS)
Mast cells are immune cells that play a vital role in defense and repair when your body needs to attack a danger or a stranger like a bacteria, viruses or even a food substance. Once these cells wake up, they become activated the mast cell opens up or “degranulates” and this releases chemicals within the body. These act as messengers to stimulate the immune response to defend and repair. These chemicals are called mediators and the Mast cells releases as many as 200 different mediators that swing into action fast within the body within a few minutes of being triggered.
Hypersensitive mast cell activation, the unregulated degranulation and release of mediators may be an underlying cause of illness for patients with many diagnoses as we can see from the range of systems it can effect on the body. Mast cell activation disorders may present as episodic inflammatory symptoms that come and go over time, making them difficult to diagnose. These symptom patterns may change and fluctuate coming and going without easily recognizable patterns and can include allergic-type responses and non-specific symptoms ranging across the heart, hormones, skin, gut and lung systems.
Common symptoms include:
Skin:
- Flushing
- Hives
- Easy bruising
- Itchiness
- Burning feeling
- Urticaria
Cardio:
- Light headedness, dizziness, feeling faint, changes in heart beat
Gastrointestinal:
- Diarrhea and or / constipation, cramping,
- Nausea, vomiting, acid reflux
Neuropsychiatric:
- Headache
- Fatigue/ lethargy
- Lack concentration
Respiratory
- Congestion, coughing, wheezing
Systemic
- Anaphylaxis
The connection between MCAS and chronic illness is an intricate clinical topic, and confirming an MCAS diagnosis may be difficult; 4, 6 however, functional medicine is uniquely positioned to effectively investigate, treat, and support this complicated condition, through a systems biology approach to health.
When I came across the latest podcast from IFM about Mast Cell Activation Syndrome (MCAS), I started thinking of so many of my patients that I see on a daily basis with a mix of some (or many) of these symptoms with diagnosis of sinus, food sensitivities or stress. Many of them feeling despondent that they are going from doctor to doctor without getting a diagnosis or treatment that improves their quality of life. When we learn about the effects of mast cell activation and the effects of the release of the mediators we can begin to understand that for these patients it’s not one symptom = one separate illness but the myriad of all the symptoms could be blanketed under this syndrome called MCAS with a complex immune reaction going on in the body. If you feel you fit into this category of allergy and inflammation, and have many diagnosis over the past ending in”…itis” like gastritis, sinusitis, esophagitis, pharyngitis, you may want to consider educating yourself more about MCAS. The treatment of which is important to avoid further escalation of the immune system.
I loved listening to the latest IFM podcast with Dr Gregory Gregory A. Plotnikoff, MD, MTS, FACP, and IFMCP, explaining the biology, cause and effects as well as treatment of MCAS which I will share with you here.
What is the Functional Medicine approach to treatment of MCAS?
First step is to try and find your specific triggers and avoid them. For the patient whom I shared her case story we identified dairy, animal hair, coriander, red wine and chocolate (which she denied). It also seems to be dose dependent if we have all of these mixed or too much of one it triggered a flare. At other times eating these or exposure to these triggers in moderation was ok.
Secondly the use of Histamine H1 and H2 blockers (anti-histamines). As a homeopath and IFM practitioner I love to work with plants so the use of Quercetin and the properties of its polyphenols as an anti-histamine is valuable in my practice. More info about quercetin below.
Thirdly a low histamine diet. Avoiding foods high in histamines like: strawberries, chocolate, alcohol, spinach, fermented foods. And heating up left overs especially fish.
Fourthly avoiding high cortisol i.e. high stress. The higher the cortisol the lower the threshold for mast cells to behave.
I found the connection between Covid and aggravation of symptoms interesting as we find out more about long Covid and the effects on other conditions like MCAS. 3,7,8 A 2021 online assessment-based study investigated the prevalence and severity of mast cell activation symptoms in those individuals experiencing long-COVID-19 illness (n=136).8 For comparison, general population controls (n=136) and MCAS patients who never had COVID-19 symptoms (n=80) were recruited. Based upon symptom evaluation between groups and controls, results indicated that mast cell activation symptoms were increased in those experiencing long-COVID-19 illness and were reflective of symptoms and severity reported by patients with MCAS.8 As research reveals additional overlaps between mast cell activation and chronic disease, infection, and illness, potential underlying causes and approaches for effective treatment will become clearer.
The use of Quercetin for mast cell activation.
In this study, Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016 May 12 (Mlcek J, Jurikova T, Skrovankova S, Sochor J), Allergic disorders (skin, food and respiratory allergies) have been rapidly increasing worldwide during the last three decades. Therefore, there is a demand for new sources of anti-allergic bioactive compounds. Nowadays, most attention has been focused on flavonoids, especially quercetin. Quercetin displays high antioxidant and anti-inflammatory properties that have been proven by many in vivo and in vitro studies. Quercetin’s anti-allergic mechanism of action through the inhibition of enzymes and inflammatory mediators has also been extensively studied. It is well known that quercetin is an inhibitor of human mast cell activation through the inhibition of Ca2+ influx, histamine, leukotrienes and prostaglandins release. This review also summarizes the role of quercetin in relation to respiratory allergic diseases (in vitro, animal and epidemiological studies) and food allergies. The results of the studies prove a unique position of quercetin in the treatment of allergic disorders and the possibility of using phytochemicals such as quercetin for an efficient cure (9).
References
- Giannetti A, Filice E, Caffarelli C, Ricci G, Pession A. Mast cell activation disorders. Medicina (Kaunas). 2021;57(2):124. doi:10.3390/medicina57020124
- Weinstock LB, Pace LA, Rezaie A, Afrin LB, Molderings GJ. Mast cell activation syndrome: a primer for the gastroenterologist. Dig Dis Sci. 2021;66(4):965-982. doi:10.1007/s10620-020-06264-9
- Afrin LB, Weinstock LB, Molderings GJ. COVID-19 hyperinflammation and post-COVID-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis. 2020;100:327-332. doi:10.1016/j.ijid.2020.09.016
- Rooted in mast cell activation syndrome. Int J Infect Dis. 2020;100:327-332. doi:10.1016/j.ijid.2020.09.016
- Matito A, Escribese MM, Longo N, et al. Clinical approach to mast cell activation syndromes: a practical overview. J Investig Allergol Clin Immunol. 2021;31(6). doi:10.18176/jiaci.0675
- Valent P, Akin C, Nedoszytko B, et al. Diagnosis, classification and management of mast cell activation syndromes (MCAS) in the era of personalized medicine. Int J Mol Sci. 2020;21(23):9030. doi:10.3390/ijms21239030
7. Weinstock LB, Brook JB, Walters AS, Goris A, Afrin LB, Molderings GJ. Mast cell activation symptoms are prevalent in long-COVID. Int J Infect Dis. 2021;112:217-226. doi:10.1016/j.ijid.2021.09.043
8. Wechsler JB, Butuci M, Wong A, Kamboj AP, Youngblood BA. Mast cell activation is associated with post-acute COVID 19 syndrome. Allergy. 2022;77(4):1288-1291. doi:10.1111/all.15188
9. Mlcek J, Jurikova T, Skrovankova S, Sochor J. Quercetin and Its Anti-Allergic Immune Response.
Molecules. 2016 May 12;21(5):623. doi: 10.3390/molecules21050623. PMID: 27187333; PMCID:
PMC6273625.