The Rise of Mast Cell Activation Syndrome (MCAS)

We’ve had an increase in enquiries recently from clients who have been diagnosed with Mast Cell Activation Syndrome (MCAS) asking how we can help, so in this month’s blog we’re going explain what it is, why more people are being diagnosed with it than ever, the difference between MCAS and histamine intolerance and how Positive Association Technique (PAT) can assist with symptoms.

MCAS is a dysregulation of your mast cells, it’s a condition that causes mast cells to release a disproportionate amount of chemicals into your body that can cause allergy and other types of symptoms anywhere in your body. It is estimated that about 17% of the population may have this condition, but don’t know it! (1)

What are mast cells?

Mast cells are white blood cells that are part of your immune system, they help you fight infections but are also involved in allergic reactions. Mast cells live longer than normal cells because they play a part in your immune systems early response to viruses and pathogens and are found in the highest numbers where your body meets the outside world, being your skin, lungs and digestive tract, but are in fact present in every tissue of our bodies except the retina in the eye.

Mast cells are responsible for immediate allergic reactions. They cause the allergic symptoms of itchy or swollen skin, mucus build up, tighten airways, wheezing, headaches and anaphylaxis by releasing products called mediators stored inside or made by them.  

In allergic reactions this release occurs when the allergy antibody IgE, which is present in mast cell surfaces, binds to proteins that cause allergies called allergens, (like pollens, dust mites, or certain foods).  

This triggering is called activation and the release of mediators is called deregulation. Some of these mediators are stored as granules in the mast cells and are released quickly and others are made slowly only after the cell has been triggered. Mast cells can also be activated by other substances such as mould, medications, infections, insect or reptile bites. 

Mast cells are involved in your body’s inflammatory response by releasing inflammatory mediators like histamine when you are exposed to a pathogen or allergen. Histamine is the most commonly known but not the only mediator, there are over 1000 including prostaglandins, interleukins, cytokines and substance P to name a few. 

In people affected by MCAS the mast cell mediators are released too frequently or profusely in response to triggers that are not supposed to be harmful, such as foods or chemicals in the environment. 

This leads to a wide range of symptoms as it can affect multiple parts of the body, depending on which mast cells in the body are dysregulated, which receptors are affected, and which mediators are being over released. 

What are the symptoms of MCAS?

Symptoms vary depending on what body system is involved but chronic fatigue, chronic muscle and joint pain are common, and hypermobility of the joints has also been linked. Because mast cells are present in your bone marrow they can also cause bone pain. 

On the skin it can cause skin conditions like itching, flushing, hives, red irritated eyes, skin burning, slow healing of skin, rosacea, psoriasis and eczema. 

With the respiratory system symptoms can be wheezing, asthma, shortness of breath, sinus congestion, post nasal drip. 

Gastrointestinal symptoms can be diarrhea, constipation, acid reflux, IBS, trouble swallowing, throat tightness and mouth burning.

Hair loss can be quite common because the hair follicles are inflamed and can’t hold onto the root. 

In the cardiovascular system there can be chest pains, heart palpitations, and a rapid heart beat.

Because of the way the immune system works with the mast cells, almost every form of autoimmune conditions will have MCAS involvement as well.

MCAS can also contribute to endometriosis, painful menstruation, hormonal balances,  inflammation in the urinary tract, bladder burning and pain is common in both men and women. Almost all chronic inflammation has a connection with MCAS. 

People who have a lot of sensitivities with foods, smells, and can’t tolerate supplements or medications often have MCAS as well. 

So you can see it really does affect every part of the body and depending on what is happening to you at the time depends on what symptoms you will get. Because of this figuring out if you have it can be tricky but if you have symptoms that affect more than one body system, (like your skin and gastrointestinal tract), the symptoms come and go or are cyclical, there seem to be lot or different triggers or it’s really hard to find out what those triggers are or you have had a dramatic change in symptoms you may have MCAS. 

But a major clue is that if taking antihistamines reduces or relieves the symptoms, then you may have it. Although to properly diagnose it, you need to seek medical advice and testing.

How does MCAS differ from histamine intolerance?

When there is ongoing mast cell activation it can make it increasingly difficult for your body to process the excess histamine which can cause you to develop histamine intolerance and its related symptoms. 

The difference between MCAS and histamine intolerance is that MCAS secrete multiple mediators in addition to histamine, whereas in histamine intolerance the mast cells only release histamine and nothing else.

What causes MCAS?

There are several factors which can trigger MCAS, but there are two major ones we have had more exposure to over the last few years.

Firstly, COVID has created a spike in MCAS sufferers as the COVID virus can cause excessive disruption of the mast cells, which can make them become ‘super-senitized’. This triggers the release of an excess of many inflammatory mediators like histamine, creating a ‘cytokine storm’ that can cause more severe symptoms and sometimes lead to hospitalization.   

Once the mast cell response is turned up it sometimes doesn’t go down after the virus is cleared from the body, so the immune system remains active. This can cause long covid and trigger the development of allergies, sensitivities and intolerances to food or environmental substances.

This doesn’t just affect adults, children with food allergies and asthma had a higher rate of getting severe covid and a higher risk of long covid with lasting symptoms of fatigue, sensory changes and sleep problems.

The second factor we’ve been exposed to over the past few years due to La Nina is mould.

Chronic mould exposure means you are inhaling mould mycotoxins, which can cause your immune system to be on high alert at all times, in an attempt to protect you from ongoing danger, but actually causes inflammation and the excess release of histamine and other mediators which can trigger MCAS (2). 

If you have had flooding and water damage in your house or work and have started to get symptoms it is important to find out if you have a mold problem and sort it out as it will continue to dampen your immune response, disrupt your hormones, affect your detoxification pathways, nervous system and gut health.

Hormonal imbalance can also be a big contributor to MCAS. Ladies, you may have noticed that your allergy symptoms get worse at certain times during your menstrual cycle or your symptoms have increased since perimenopause.  

It may be an increase in your hay fever symptoms from seasonal allergies, foods you were previously able to eat are now giving you skin irritations or digestive problems and alcohol, especially red wine, can give you a sleepless night after drinking it. 

This is because high histamine levels occur when estrogen is high, which is during ovulation,  just before your period and the ever fluctuating time that is perimenopause. 

The problem is estrogen stimulates mast cells to release histamine and down regulates an enzyme called DAO which clears histamine from the body. The complicated part is that at the same time histamine stimulates the ovaries to make more estrogen! So you get this pattern of estrogen-histamine-estrogen-histamine which can trigger MCAS.

The issue with perimenopause and menopause in particular is that estrogen and progesterone receptors are on these mast cells too, which is why menopausal hormonal changes affect the release of histamine from mast cells in response to compounds which stimulate an allergic reaction in the body. 

The link between MCAS and the Nervous System

As mast cells also release some neurotransmitters and neuropeptides, they are in communication with the nervous system. They reside alongside every nerve sheath and nerve ending so they are a connection point between the nervous system and the rest of the body.

This is why stress can cause mast cells to be activated (3), and the stress of having MCAS can cause more symptoms to develop, so it’s a vicious cycle of symptoms!  

Managing your stress is very important or and can cause a flare up when you are feeling this way. The most important parts of the nervous system to focus on are the limbic system and the vagus nerve.

It also affects the brain with brain fog and trouble recalling words being common. There can be headaches, anxiety, depression, insomnia, and tinnitus as well.

How can MCAS be managed?

To keep histamine in balance, after mast cells make it, the enzymes histamine N – methyltransferase (HNMT) and diamine oxidase (DAO) clear it out of your system. But this can become unbalanced if too much histamine comes in.  

This can happen from having too much estrogen in the body, eating high histamine foods, mast cell activation from inflammation, food sensitivities, too much alcohol, or from intestinal gut dysbiosis.

So firstly we can reduce foods that contain histamine, and mediate the release of it. Histamine is in a wide range of foods that need to ripen before being eaten, or are fermented so a major problem for MCAS is the popularity of fermented foods, as they contain high amounts of histamine producing bacteria. We can send you a full list of foods that contain and mediate the release of histamine, just get in touch via our website. There are also mast cell-stimulating foods such as Alcohol, cow’s dairy (A2 milk ok) 

So try to eat as fresh as possible, as any foods with bacteria on them can create high histamine, avoid anything out of date, moldy, aged meats, even leftovers from previous meals can build up with extra histamine. Lectins and salicylates can also trigger mast cells in some people too.

Some probiotics can also raise histamine levels, so it is important to get the right strains as there are mast cells lining your gut wall and about 80% of your immune system is in your gut, so its health is very important! Lactobacillus rhamnosus is a strain that is low in histamine and also helps lower overall histamine levels in your body. 

We also need to manage our stress levels, as there’s a link between cortisol and histamine as well as MCAS. We actually did a whole episode about cortisol, which we will link in the show notes. Managing your stress will not only help manage your MCAS symptoms, but so many other areas of your life too!

How can Positive Association Technique (PAT) assist with MCAS?

Allergies, sensitivities and intolerances are both a symptom and an underlying driver of MCAS. So by addressing the symptoms of these reactions with PAT, we’re able to help reduce overall histamine and inflammation levels in the body, which is going to be one piece of the puzzle in correcting mast cell dysregulation.

Some of the common PAT treatments we do for clients with MCAS include salicylates, lectins, mould and we even do a PAT treatment for histamine, which is especially beneficial for clients with MCAS or histamine intolerance.

Histamine naturally occurs in some foods, other foods can mediate the release of histamine, and histamine is also produced when we’re reacting to something. So when someone is reacting to their own histamine as well, it can create this vicious cycle of excess histamine production. So our PAT treatment for histamine aims to help reduce this reaction and dampen this cycle. 

As part of an Initial PAT Consultation, we use a technique called muscle testing (or kinesiology) to help pinpoint your reactions to various foods, food chemicals, airborne and chemical substances.

Following testing, you can work with your qualified Naturopath to address the reactions to these substances using a natural allergy treatment called Positive Association Technique (PAT).

We have clinics located all over Australia and in Auckland, New Zealand, and help hundreds of people manage their symptoms each year.

To find out more about how we can help you, get in touch!

• Call us on 1300 853 023 / 09 479 5997 (NZ) to chat to our friendly staff
• Send us your question HERE
• Request a Free PAT Information E-PACK HERE

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Please note that this blog post contains general information only. Always consult your health care professional before changing your diet, starting new supplements or regarding any medical condition.