Mast Cell Activation Syndrome (MCAS) & Lyme Disease

What are Mast Cells?

Mast cells are immune cells that originate in the bone marrow and release up to 200 signalling chemicals, or mast cell mediators, into the body as part of an immune system stabilizing defense response against foreign invaders (parasites, fungi, bacteria, or viruses), allergens and environmental toxins and contribute to tissue homeostasis and repair, according to Matthew J. Hamilton, MD associate gastroenterologist at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School, Boston

We need mast cells to protect us from infection, heal wounds, create new blood cells, and develop immune tolerance. However, in conditions in which these cells are dysfunctional or overactive, they can cause serious issues.

MCAS Symptoms and Treatment

Mast cells are found in most tissues throughout your body. In particular, they are found in tissues that are in close contact with the environment such as your skin, airways, and gastrointestinal tract. Mast cells are also found in your cardiovascular, nervous, and reproductive systems.

MCAS is often found in individuals with hypermobility syndromes (Ehlers–Danlos syndrome), postural orthostatic hypotension (POTS) as well as chronic inflammatory response syndrome (CIRS) and tick-borne illnesses (Lyme disease and co-infections).

MCAS Symptoms

The most common symptoms of MCAS include:

  1. Feeling as though you have been sick forever
  2. Trouble with allergies and asthma
  3. Overreaction to insect bites, bee stings and chemical intolerances
  4. Facial and chest flushing
  5. Skin rashes that come and go, including hives and angioedema
  6. Itchiness and a burning feeling
  7. Brain fog and headaches
  8. Poor wound healing and easy bruising
  9. Waxing and waning of symptoms
Mast Cell Activation Syndrome

The condition may be mild in some people and only exacerbate in response to a significant life stressor, which may be either physical or psychological in nature. In others, symptoms may develop from a young age and slowly become worse over time. People with MCAS are likely to experience a few of the most common symptoms. Because mast cells are located throughout the body, symptoms can affect the eyes, nose, ears, throat, skin, heart, blood, lungs, gastrointestinal tract and the nervous, endocrine and musculoskeletal systems.

The symptoms of MCAS are often confusing. For a long time, many people with MCAS have been told that their condition was psychosomatic or ‘in their head’. Fortunately, awareness of this frustrating and debilitating condition is spreading. Testing for MCAS is somewhat complex and confusing, as positive biomarkers may only be observed when a patient has a flare up. Incorrect collection of specimens may also lead to false negative testing.

Mast Cell Activation and Triggers

Mast cells can be activated to release mediators by multiple triggers. Possible triggers of mediator release are shown below in Figure 1.

Heat, cold or sudden temperature changes Stress: emotional, physical, including pain, or environmental.
Exercise Fatigue
Alcohol Drugs, antibiotics and some local anesthetics
Natural and chemical odors Venoms
Infections Sun/sunlight

Any patient with a mast cell disease can potentially react to any trigger, and triggers can change over the course of the condition. In addition, patients may experience reactions to virtually any medications, including medications that they have tolerated previously.

Most people with MCAS have chronic and recurrent inflammation, with or without allergic symptoms. This occurs when an aspect of the innate immune system becomes overactive and releases a flood of inflammatory chemicals, which may affect every organ in the body.

MCAS Treatment

Although there is a good possibility that you will eventually find the right therapeutic combination of treatments that will help alleviate many of your symptoms, the fact is that there are no specific biomarkers that will predict which therapy will be the most effective for your specific manifestation of this condition. Much of the treatment plan for MCAS is similar to the biological treatment of Lyme disease. Also, if you opt for natural treatments for MCAS, always be sure to disclose everything you are taking to your doctor so he or she has a clear idea of what is going on. It is also important that you make only one change at a time when attempting different combinations of treatment options.

Advantages of Using Natural Treatments for Mast Cell Activation Syndrome

There are many advantages of using natural treatments for MCAS, including:

  1. MCAS patients are often sensitive to pharmaceuticals, particularly the excipients (bulking agents, binders, fillers, dyes) within the products. Patients will have to work closely with their compounding pharmacists to help identify a list of offending ingredients in drug formulations. If a patient has a strange reaction to medications (e.g. insomnia while using a typically sedating antihistamine), it is likely a flare up of mast cells in the CNS causing the problem and not the drug itself.
  2. Some drugs block DAO—an enzyme in the gut that breaks down histamine
  3. Many patients prefer natural treatments
  4. May have benefits beyond mast cell stabilisation

Many patients find that these natural treatments are sufficient when it comes to treating their MCAS. For others, these natural treatments allow them to reduce the number or amount of drugs they need. When it comes to natural treatments for MCAS, the most effective work in the following ways:

  1. Stabilising mast cells
  2. Increasing histamine breakdown
  3. Reducing histamine levels
  4. Stabilising the immune system and reducing inflammation

With that in mind, here are some of the best natural treatments for MCAS according to the mechanisms they influence. These recommendations were presented at a think tank by Dr Brian Bouch, a leading integrative medical doctor from California.

  • Stabilising Mast Cells

One of the best things you can do for MCAS is add natural treatments that stabilise your mast cells. Such therapies work by inhibiting the inflammatory mediators mast cells release.

  • Increasing Histamine Breakdown

Diamine oxidase (DAO) stabilizes mast cells, but more importantly, it is the predominant enzyme that breaks down histamine. To increase DAO levels, one can take DAO enzymes and with high doses of vitamin C.  

You should also avoid anything that blocks the release of DAO. First and foremost, this includes any form of alcohol. Histamine and alcohol metabolic pathways share common enzymes—aldehyde oxidase and aldehyde dehydrogenase. When alcohol is consumed, histamine is released from your mast cells and DAO is simultaneously inhibited. This can cause a runaway chain reaction, which results in greater sensitivity to alcohol and worsening histamine intolerance.

  • Reducing Histamine Levels

To reduce histamine levels in your body, you should adopt a low histamine diet. Avoid the following:

AlcoholSeafoodSmoked and cured meat
Pickled foodsLeftoversFermented foods
Canned fish or meatVinegarPreservatives

Try to eat foods as fresh as possible, and stick to anti-inflammatory foods.

  • Stabilising the Immune System and Reducing Inflammation

Calming the immune system and reducing inflammation is a critical part of any MCAS protocol. The recommendations above mainly help to stabilise the immune system and reduce inflammation, though there are a few other effective methods:

  1. Check and treat any underlying infections – These can contribute to a widespread inflammatory response in the body if left untreated. These may include H. pylori, Epstein Barr and herpes simplex.
  2. Correct gut dysbiosis – Correcting the balance of your gut microbiome has been shown to reduce inflammation and improve immune system health.

There is a lot you can do to minimize the condition’s impact on your life. The good news is that most of the natural treatments for MCAS are recommendations for a healthier life that anyone would benefit from. With a chronic illness such as MCAS, it is possible to live a full life—the treatment just requires a careful, comprehensive approach.

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