Hi guys, for thouse who are intrested, diagnosing of MCAS is simple
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https://hoffmancentre.com/mast-cell-activation-syndrome-histamine-immune-system-runs-rampant/If you’re interested in getting lab work done to check for MCAS, I recommend the tests listed below. The top five, in bold, are the most important and necessary to establish a diagnosis:
1. Histamine – plasma – Quest 36586 – must be chilled. Normal range – 28-51 ug/l.
2. N-Methylhistamine – 24-hour urine – must be chilled. Normal range – less than 200 mcg/g.
. Prostaglandin D2 – plasma – must be chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
4. Prostaglandin D2 (PGD2) – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
5. Chromogranin A – Quest 16379 – must be off proton pump inhibitors (PPIs) and H2 blockers (Pepcid and Zantac) for 5 days before tests, since they can falsely elevate chromogranin A.
6. Prostaglandin 11-beta F2 Alpha (PGF2alpha) – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
7. Serum Tryptase – Quest 34484. Rarely elevated in MCAS. NR less than 11.5 ng/ml. Positive if increase over baseline of 20% or baseline greater than 15.
8. Leukotriene E4 – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
9. Plasma heparin Anti-XA (must be off heparin products) – chilled. Degrades quickly.
10. Blood clotting profile – Thrombin/PT/PTT/INR.
11. Anti-IgE Receptor antibody.
12.Neuron Specific Enolase – Quest 34476.
13.Plasma pheochromocytoma workup.
14.Porphyria workup.
15.Factor VIII deficiency.
16.Plasma free norepinephrine – Quest 37562.
17.Urinary metanephrines – can b done in normal Calgary labs.
18.Immunoglobulins – IgG, IgM, IgE, IgA
19.Bone marrow biopsy looking for the following markers: CD117/CD25; CD117/CD2.
20.Gastrin
21.Ferritin
22.CBC – eosinophils, basophils.
23.Antiphospholipid antibodies.
24.Genetic testing looking for Phase 1 and Phase II liver detox and methylation defects.
25.Dunwoody Labs – test zonulin, histamine, DAO enzyme deficiency.
Patients who come into my office with MCAS usually have multisystem, multisymptom inflammatory responses. These symptoms have often caused them to trudge from doctor to doctor, undergoing rounds of testing, causing them to feel extraordinarily confused as to what’s happening to their body. Because the symptoms of MCAS have so broad a reach and differ so considerably from person to person I’d like to break them down by nonspecific, general clues, and organ system signs.
Most Common General Symptoms:
“I’ve been sick for as long as I can remember”
“I overreact to bee stings, mosquito bites, penicillin and most medications”
“I can’t take a full breath”
“Whenever I stand up I get lightheaded”
Insomnia/sleep disorders starting early in life
Tinnitus/ringing in the ears from a young age
Vomiting as an infant
Abdominal pain as an infant
Facial and chest flushing ( a red flush when embarrassed or stressed)
Dermatographism—a red line appearing on the skin when scratched with a blunt object
Frequent infections, cold, viruses, gut viruses as an infant, adolescent or adult
Fatigue and malaise
Frequent fevers
Edema—“water” accumulation in different parts of body
Waxing and waning of symptoms
Food, drug, and chemical intolerances (especially fragrances). This is a very common symptom which may be exacerbated by phase 1 and phase II liver detoxification problems as identified by gene testing
Sense of being cold all the time
Decreased wound healing
Hypersensitivity to much in environment, including medications
Weight gain or loss
Heat intolerance
Frequent family history of cancer, especially intestinal or bone marrow (hematologic)
Generally feeling inflamed
Generalized lymphadenopathy (enlarged lymph nodes)
MCAS Symptoms by Organ System
Eyes – Red eyes, irritated eyes, dry eyes, burning eyes, difficulty focusing vision, and conjunctivitis (pink eye).
Nose – Nasal stuffiness, sinusitis, postnasal drip, hoarseness, laryngitis, nose bleeds (epistaxis), and intranasal sores.
Ears – Ringing in ears (tinnitus) and Eustachian tube dysfunction (blocked, popping ears).
Throat – Vocal cord dysfunction, throat swelling, sores on tongue/mouth, itchy throat, burning mouth, and difficulty swallowing
Skin – Hives, angioedema (swelling of the skin), skin flushing, itching, skin rashes, dermatographism (when scratched skin causes a red welt), chronic itching, urticarial pigmentosa (legion/hive-like spots on the skin), flushing, bruising easily, reddish or pale complexion, cherry angiomata (skin growths), patchy red rashes, red face in the morning, cuts that won’t heal, fungal skin infections, and lichen planus.
Cardiovascular – Fainting, fainting upon standing, increased pulse rate (tachycardia), palpitations, spikes and drops in blood pressure, high pulse or temperature, high triglycerides, lightheadedness, dizzy, hot flashes, and postural orthostatic hypotension syndrome (POTS).
Respiratory – Wheezing, asthma, shortness of breath, difficulty breathing deep, air hunger, dry cough, chronic obstructive pulmonary disease (COPD), and chronic interstitial fibrosis.
GI Tract – Left upper abdominal pain, splenomegaly (enlarged spleen) epigastric tenderness, nausea, vomiting, diarrhea and/or constipation, abdominal cramping, bloating, non-cardiac chest pain, malabsorption, GERD/acid reflux, cyclic vomiting syndrome, colonic polyps, and gastric polyps.
Liver – High bilirubin, elevated liver enzymes, and high cholesterol.
Neurological – Numbness and tingling (especially in the hands and feet), headaches, migraines tics, tremors, pseudo-seizures, true seizures, waxing and waning brain fog, memory loss, poor concentration, difficulty finding words, and spells of cataplexy (suddenly becoming disconnected from and unresponsive or unreactive to the world around).
Musculoskeletal – Muscle pain, fibromyalgia, increased osteopenia, osteoporosis, weakness, and migratory arthritis (joint pain).
Coagulation – History of clots, deep vein thrombosis, increased bruising, heavy menstrual bleeding, bleeding nose, and cuts that won’t stop bleeding.
Blood disorders – Anemia, increased white blood cell count, platelets, decreased white blood cell counts, decreased neutrophils, decreased lymphocytes, decreased platelets, reductions in CD4 helper lymphocytes, reductions in CD8 positive suppressor lymphocytes, reductions or excesses of IgA, IgG, IgM, IgE, a known condition called MGUS, myelodysplastic syndrome (reduced red cells, white cells, platelets), and increased MCV (mean corpuscular volume).
Psychiatry – Anxiety, panic, depression, obsessive compulsive disorder (OCD), decreased attention span, attention deficit/hyperactivity disorder (ADHD), forgetfulness, and insomnia.
Genitourinary – Interstitial cystitis, recurrent bladder infections, sterile bladder infections, and frequent urination.
Hormones – Decreased libido, painful periods, heavy periods, infertility, and decreased sperm counts.
Dental – Deteriorating teeth.
Anaphylaxis – Difficulty breathing, itchy hives, flushing or pale skin, feeling warm after exposure, weak and rapid pulse, nausea, vomiting, diarrhea, dizziness and fainting.
Figure 1. Some Potential Mast Cell Triggers2-5
Heat, cold or sudden temperature changes
Stress: emotional, physical, including pain, or environmental (i.e., weather changes, pollution, pollen, pet dander, etc.)
Exercise
Fatigue
Food or beverages, including alcohol
Drugs (opioids, NSAIDs, antibiotics and some local anesthetics) and contrast dyes
Natural odors, chemical odors, perfumes and scents
Venoms (bee, wasp, mixed vespids, spiders, fire ants, jelly fish, snakes, biting insects, such as flies, mosquitos and fleas, etc.)
Infections (viral, bacterial or fungal)
Mechanical irritation, friction, vibration
Sun/sunlight
Conditions Associated with Mast Cell Activation Syndrome
Because MCAS is a chronic, multisystem, multisymptom condition with an inflammatory theme, it’s been associated with a number of conditions and diseases, including:
Chronic inflammatory response syndrome
Irritable bowel syndrome
Gut dysbiosis – the gut is rich in mast cells and home to over 70% of the immune system. Parasites, bacteria, fungi, and parasites can all trigger gut mast cells.
Obesity
Diabetes
Asthma and allergies
Autism
Autoimmune diseases (such as lupus, rheumatoid arthritis, and Hashimoto’s)
Candida overgrowth
Celiac disease
Parasite infections
Skin conditions such as eczema and psoriasis
Food intolerances and allergies
Gastroesophageal reflux (GERD)
Infertility and endometriosis
Chemical and medication sensitivities
Postural orthostatic hypotension (POTS)
CIRS – exposure to mold mycotoxins is a potent stimulator of mast cell activation
Migraines
Depression
Fibromyalgia
Fungal infections
Tinnitus
Multiple Sclerosis
Cancer
MEDIATOR POSSIBLE EFFECTS
Histamine Flushing, itching, diarrhea, hypotension
Leukotrienes Shortness of breath
Prostaglandins Flushing, bone pain, brain fog, cramping
Tryptase Osteoporosis, skin lesions
Interleukins Fatigue, weight loss, enlarged lymph nodes
Heparin Osteoporosis, problems with clotting/bleeding
Tumor Necrosis Factor-? Fatigue, headaches, body aches
MAST CELL MEDIATOR SYMPTOMS
Anaphylaxis
Flushing of the face, neck, and chest
Itching, +/- rash
Hives, skin rashes
Angioedema (swelling)
Nasal itching and congestion
Wheezing and shortness of breath
Throat itching and swelling
Headache and/or brain fog, cognitive dysfunction, anxiety, depression
Diarrhea, nausea, vomiting, abdominal pain, bloating, gastroesophageal reflux disease (GERD)
Bone/muscle pain, osteosclerosis, osteopenia, osteoporosis
Light-headedness, syncope/fainting
Rapid heart rate, chest pain
Low blood pressure, high blood pressure at the start of a reaction, blood pressure instability
Uterine cramps or bleeding
