MCAS (mast cell activation syndrome) is a condition characterized by frequent episodes of anaphylaxis-like symptoms. Anaphylaxis is a potentially life-threatening allergic reaction to an allergen.
These allergic symptoms include low blood pressure, vomiting, and nausea. During these episodes, high levels of mast cell mediators are discharged.
An MCAS assessment begins with deciding whether the symptoms happened in separate attacks and are the usual symptoms of an anaphylactic reaction without a distinct cause. Mast cell mediators grow during the episode. Those mediators must be evaluated during acute episodes and at baseline, looking for increases during symptoms.
The Functionality of Mast Cells
Mast cells are a part of your immune system. The functionality of mast cells is to help defend your body against invading germs such as pathogens or viruses. They lie in your tissues and when they identify something they think is unsafe, they discharge histamine and other chemicals to trigger your immune system and attempt to eliminate the intruder.
Sometimes, they respond to things they shouldn’t, which is when allergies come into the picture. However, allergies typically only cause your nose to run and your eyes to water or give you other minor symptoms. MCAS creates more severe symptoms without certain triggers.
What is Mast Cell Activation Syndrome (MCAS)?
Mast cell activation syndrome (MCAS) is when you have inexplicable episodes of serious symptoms such as:
- Itching
- Vomiting
- Swelling
- Diarrhea
- Flushing
Unlike allergies, which occur when you touch something you react to or eat a particular food item, MCAS episodes happen without a distinct trigger.
Mast cells are a sort of immune cells in charge of immune reactions. While it can be frightening to have strange symptoms and desire answers, activation of mast cells is typical. For example, conditions like asthma and allergic rhinitis, allergic reactions (anaphylaxis to food or drugs), and mastocytosis all trigger mast cells. This makes them discharge proteins that give you symptoms that are irritating at best and hazardous at worst. Other usual conditions could also create strange symptoms.
There are times when there is no trigger. This is called idiopathic MCAS. Idiopathic means there is no obvious cause. When you don’t know what is producing the symptoms, MCAS can be exasperating to manage. Medications may help lessen the frequency and seriousness of the symptoms.
Symptoms
Releasing too many mast cell mediators can affect nearly every part of your body. The main affected areas usually include your:
- Skin
- Gastrointestinal tract
- Nervous system
- Heart
The number of mediators discharged could produce symptoms that go from minor to lethal. Symptoms might include:
Heart and blood vessels – rapid heart rate, low blood pressure
Skin – sweating, flushing, rash, hives, swelling
Lungs – wheezing, trouble breathing
Eyes – watering, irritation, itching
Nose – running, itching
Mouth and throat – swelling in your throat, itching, swelling in your lips or tongue
Nervous system – Headache, fatigue, confusion
Stomach and intestines – abdominal pain, nausea, cramping, diarrhea
In serious cases, you might experience anaphylactic shock. This condition necessitates emergency treatment. Symptoms can include:
- Weak pulse
- Confusion
- A swift drop in blood pressure
- Loss of consciousness
- Breathing problems
- Lightheadedness
Is Mast Cell Activation Syndrome Serious?
The seriousness of MCAS is based on your symptoms. It could be fairly mild with just skin-related symptoms. However, it could also produce bouts of anaphylaxis, which can be lethal if not treated immediately. Life-threatening, serious reactions because of mast cell activation syndrome are very rare.
Triggers of Mast Cells Activation
Triggers for mast cell activation may differ. Here are some typical ones:
- Friction
- Some beverages and food
- Alcohol
- Stress
- Certain scents and odors
- Exercise
- Certain drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics
- Bug bites and stings
- Allergens (mold and pollen)
- Temperature changes (hot or cold)
Allergy immunotherapy or allergy shots for pollen or mold could also cause systemic MCAS reactions. If someone is experiencing symptoms of anaphylactic shock, call 911 for emergency medical assistance.
Diagnosing MCAS
According to the AAAAI (American Academy of Allergy, Asthma & Immunology), here are the criteria for diagnosing MCAS:
- Tests reveal high levels of one or more mast cell mediators
- Urine or blood tests taken during an episode reveal elevated levels of markers for mediators or their metabolites as opposed to when you’re not experiencing an episode.
- You have serious, chronic symptoms (usually anaphylaxis) that impact at least two organs.
MCAS Treatments
Currently, there is no cure for MCAS. However, there are ways to manage the symptoms. MCAS can be managed efficiently with medications. It’s also vital to recognize your triggers and prevent them. Treatments can include:
H1 or H2 antihistamines – These treatments block the impacts of histamine, which is one of the key mediators that mast cells discharge. Histamine type 1 receptor blockers include loratadine and cetirizine which can aid with symptoms, including stomach pain and itching. Histamine type 2 receptor blockers, including ranitidine and famotidine, can help treat nausea and abdomen pain.
Aspirin – This might reduce flushing.
Mast cell stabilizers – Omalizumab can help stop the release of mediators from mast cells, causing fewer episodes of anaphylaxis.
Antileukotrienes – Antileukotrine medications, like montelukast and zafirlukast, impede the effects of leukotrienes, a usual type of mediator, to deal with stomach cramps and wheezing.
Corticosteroids –These must only be used as a last resort for the treatment of hives, edema, or wheezing.
Leukotriene modifiers – These medications lessen the impacts of leukotrienes, a kind of inflammatory mediator release. They might be helpful in some individuals with mast cell activation syndromes. Zileuton, montelukast, and zafirlukast are leukotriene inhibitors.
Diet – Presently, no studies observe or examine the relationship between MCAS and changes in diet. If a physician diagnoses you with secondary MCAS, you might discover that certain foods and drinks will trigger your symptoms. You should discuss changes to your diet with your doctor and avoid food and drinks that cause a reaction. If you have symptoms of an allergy after eating a particular food or consuming a specific drink, you might have an allergic reaction instead of MCAS.
Some anecdotal evidence implies that diet changes might help individuals with MCAS. However, large-scale and scientific evidence doesn’t validate their use for MCAS. A person could discover some benefit to trying one of the diets irrelevant to MCAS. If you develop anaphylactic shock or other serious symptoms, you’ll have to get an epinephrine injection. This could be done at a medical clinic/office, hospital, or with an EpiPen. It is crucial to note that if you use an EpiPen, you must still visit a medical facility (hospital, emergency room, or medical office).
If you frequently have severe symptoms, you should consider wearing a medical ID bracelet until you discover what your triggers are.
MCAS symptoms could impact more than one body organ, leading to anaphylaxis. The first-line treatment for anaphylaxis is epinephrine. Everyone who has MCAS should have two doses of epinephrine at all times. Tools available include an auto-injector as well as an epinephrine nasal spray. If anaphylaxis symptoms occur, get epinephrine immediately. Do not wait a minute. If symptoms are severe, or they become persistent or worse, get emergency treatment at a medical clinic or hospital.
Low histamine diet – Anecdotal evidence indicates that low histamine diets might help some individuals manage symptoms of MCAS. A low histamine diet restricts foods usually believed to be high in the chemical histamine, which mast cells discharge when they’re activated. Foods that are high in histamine can include:
- Spinach
- Alcohol
- Hard cheese
- Fish
- Sausage
Low FODMAP diet-Some people think that a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet may help MCAS. A low FODMAP alternative diet includes:
- Vegetables such as eggplant, potatoes, and carrots
- Dark chocolate
- Fruits such as grapes, kiwi, and strawberries
- Corn flakes, oats, and rice cakes
- Dairy such as almond milk, feta cheese, and soy milk made from soy protein
- Protein such as eggs and tofu
A low FODMAP diet removes food that has specific types of sugars. The plan is to limit certain foods and then reintroduce them to decide which ones could trigger any symptoms. A recent study of individuals with irritable bowel syndrome (a medical condition in which mast cells might play a role) proved that the low FODMAP diet considerably lowered contributors’ levels of histamine. This implies that the diet could impact mast cell activity. The diet includes steering clear of high FODMAP foods like:
- Dairy
- Wheat
- Legumes such as peas, beans, peanuts, and lentils
- Certain fruits such as peaches and apples
- Certain veggies such as broccoli and asparagus
It is critical to speak with a dietitian or physician before making any changes to your diet in order to make sure you are getting the correct amount of daily required nutrients.
Summary
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