Mast cell activation syndrome – what is it and how do I alleviate my allergies?

Are you constantly battling with allergies? You may have a histamine intolerance, or you may have something called mast cell activation syndrome (MCAS), sometimes known as Mast Cell Activation Disorder (MCAD).

MCAS is a condition that occurs when the mast cells in your body release too much of a substance that causes allergy-like symptoms. Histamine intolerance and MCAS are sometimes confused for one another as mast cells play a role in histamine intolerance. However, in MCAS, mast cells release multiple different types of mediators – not just histamine – whereas in histamine intolerance, it is only histamine. [1]

MCAS was officially recognised as a condition in 2007. Since then, extensive research has been conducted and our knowledge has increased significantly. So too has our ability to treat the condition naturally, reducing people’s reliance on pharmaceuticals whilst also alleviating their symptoms.

What are mast cells?

Mast cells are allergy cells responsible for immediate allergic reactions. Mast cells are part of your immune system and are present throughout your body, particularly in your bone marrow and around blood vessels.

Mast cells are especially concentrated in your:

• Skin
• Gastrointestinal tract
• Lungs
• Sinuses
• Nervous system
• Reproductive organs [1]

When people are exposed to allergens, including medications, foods, and insect venom that they are allergic to, mast cells typically react by releasing chemical mediators which cause allergic reaction. [2]

How do mast cells work?

Mast cells cause allergic symptoms by releasing mediators which are stored inside them or made by them.

In allergic reactions, this release occurs when the allergy antibody IgE, which is present on the mast cell surfaces, binds to proteins called allergens. This triggering is called activation, and the release of these mediators is called degranulation.

Some of these mediators are stored in granules in the mast cells and are released quickly and others are made slowly only after the cell has been triggered.  These mediators include histamine, tryptase, chymase, interleukins, prostaglandins, cytokines, chemokine and proteases.

Mast cells can also be activated by other substances, such as medications, infections, insect or reptile venoms.

These responses are made by normal mast cells which are called secondary activation because they are due to external stimuli.

What is Mast Cell Activation Syndrome (MCAS)?

Mast cell activation syndrome is an immune disorder. Sometimes mast cells become defective and release mediators because of abnormal internal signals.

If you have MCAS, your mast cells release these same mediators too frequently and too often on their own without being exposed to an allergen.

Certain mutations in mast cells can produce populations of identical mast cells, known as clones, that overproduce and spontaneously release mediators. The spontaneous production of mediators in these clonal mast cell disorders is called primary activation. These abnormal cells can grow uncontrollably and are unusually sensitive to activation in a condition called mastocytosis. [3]

Common conditions associated with MCAS

Many of the symptoms of MCAS are related to the cardiovascular, gastrointestinal, respiratory, and neurological systems as well as the skin. So it makes sense that there are some common conditions associated with MCAS. These include:

• Poor methylation caused by MTHFR genetic mutations (need methyl groups to help clear histamine)
• Low DAO enzyme levels (processing of histamine in the gut)
• Leaky gut, which can be made worse by excess histamine
• Histamine intolerance
• Chronic inflammatory response syndrome from water damaged building/mould exposure
• Gut dysbiosis
• Irritable bowel syndrome
• Celiac disease
• Allergies
• Asthma
• Autism
• Autoimmune disease
• Candida overgrowth
• Fibromyalgia
• Depression [4]

What are they symptoms of MCAS?

Common symptoms of MCAS can be wide-ranging and are often present very differently in individuals. Also, as we’ve seen, the condition is related to many of the body systems, its effects are varied.

Common symptoms include:

Skin-related symptoms of overactive mast cells:

• Hives
• Itching
• Swelling
• Flushing

Gastrointestinal-related symptoms of overactive mast cells:

• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping
• Bloating

  Cardiovascular-related symptoms of overactive mast cells:

• Low blood pressure
• Rapid pulse
• Passing out
• Vascular permeability (inflammation and swelling)

Respiratory-related symptoms of overactive mast cells:

• Wheezing
• Shortness of breath
• Cough
• Asthma-like symptoms
• Sinusitis
• Rhinitis
• Increased mucus production

Brain-related symptoms of overactive mast cells:

• Brain fog
• Anxiety
• Headaches
• Difficulty concentrating
• Sleeplessness
• Neuropathic pain
• Vertigo [5]

How is MCAS diagnosed?

In addition to observing and monitoring the above symptoms, laboratory tests are often required to ensure proper diagnosis of MCAS. This may mean blood, urine, stool or bone marrow tests. You may also be tested for gene mutations.

How to treat MCAS

There are many medications that are commonly used with MCAS with some of the more popular options including antihistamines, leukotriene inhibitors, and mast cell stabilizers. These all block the action of mast cell mediators and are a short-term solution to providing relief.

There are also other steps you can take in alleviating symptoms in the long term. These include:

Remove heavy metals from your system

Heavy metals are toxic to many of your organs as well as your immune system. Aluminum and mercury, particularly, have been shown to destabilise mast cells, which causes them to be overactive.

With the guidance of a Functional Medicine health practitioner, you can remove heavy metals from your body with chelating agents.

Treat infections

You may have infections that are contributing to mast cell activation. [6]

Adopt a low-histamine diet

For some people with MCAD, this can be a really effective way of reducing symptoms.

The following foods contain higher levels of histamine and are best to avoid:

• Fermented dairy products, such as cheese (especially aged), yogurt, sour cream, buttermilk and kefir
• fermented vegetables, such as sauerkraut and kimchi
• pickles or pickled veggies
• kombucha
• cured or fermented meats, such as sausages, salami, and fermented ham
• wine, beer, alcohol, and champagne
• fermented soy products such as tempeh, miso, soy sauce, and natto
• fermented grains, such as sourdough bread
• tomatoes
• eggplant
• spinach
• frozen, salted, or canned fish, such as sardines and tuna
• vinegar
• tomato sauce (ketchup) [7]

As a general rule, its best to cook all your own meals where possible, focus on fresh foods and record any symptoms when you consume a particular food so you can keep track of what your triggers are. Avoid all processed foods, artificial preservatives and sweeteners, sugar, dairy, wheat, and restricted spices.

Focus on anti-inflammatory foods that support your immune health

Ensure you are consuming probiotic, prebiotic and healing foods and foods that reduce inflammation and stabilise mast cells naturally. These include:

• Onions are an important prebiotic food and quercetin is known for its antioxidant activity in radical scavenging and anti-allergic
• Moringa is nutrient dense, and some research suggests it regulates inflammatory responses
• Chamomile has been shown to inhibit histamine release from mast cells
• Nettle has pain relieving and anti-edema effects without irritating the skin
• Galangal may downregulate mast cell–derived allergic inflammatory reactions by blocking histamine release and expression of pro-inflammatory cytokines and may be a beneficial anti-allergic inflammatory agent
• Turmeric has powerful anti-inflammatory and antioxidant properties. Curcumin, an active component of turmeric, may possess anti-inflammatory and anti-cancer activities
• Peaches have been shown to inhibit mast cell–derived allergic inflammation
• Brazil nuts have an extremely high selenium content. A 2013 study showed that selenium-treated mast cells revealed significant decrease in concentration of histamine and prostaglandin D2 and hexosaminidase
• Fibre Studies suggest dietary fibre (especially polysaccharides and oligosaccharides) and metabolites can regulate mast cell function [8]

Use supportive supplements

• Take the daily recommended dosage of vitamin C in ester form or buffered form as it can work well as an wonderful anti-histamine. It works by reducing mast cells from releasing histamine and causing histamine to break down at a quicker speed.
• For vitamin C to function at its optimal level, take a recommended dosage of calcium and magnesium ascorbates.
• Bioflavonoids can stop the mast cells from reacting and degranulating at a rapid speed. The recommended dosage is at least 800 milligrams per day in the form of quercetin.
• Vitamin B6 (also known as pyridoxal-5-phosphate or Pyridoxine HCl) is also crucial in balancing your body because it is responsible for sustaining many important bodily functions such as hormonal balance, muscle repair and growth, and bone health. It also plays an important role in removing toxins from the bloodstream. [9]

Make some lifestyle changes

• Take steps to reduce your stress levels as corticotropin hormone, released in response to physical or psychological stress, destabilizes mast cells and causes them to release their mediators
• Sleeping well throughout the night – get enough sleep and avoid blue light [10]
• Keep a good exercise routine

How we can help

Mast cell activation syndrome isn’t curable but if you’ve been diagnosed with mast cell activation syndrome, you do have treatment options available to help you manage your symptoms.

At Advanced Functional Medicine, our expert health practitioners can work with you to work with your condition and help alleviate your symptoms. If you are diagnosed with MCAS we can assist you with a nutrient-rich, low histamine diet, heal any underlying infections, ensure your gut health is optimal, balance methylation and your biochemistry, clear heavy metals, optimise your histamine pathways and use natural antihistamines to help you feel better. Contact us to find out more.