Mast Cells Activation Syndrome and Histamine Intolerance

Mast Cell Activation Syndrome (MCAS) and Histamine Intolerance are gaining more notice in integrative medicine. 

MCAS is pretty much what the name suggests--an increase and over-activity of mast cells, and their infiltration into organs. There are three types of MCAS: primary, secondary and idiopathic: 

1. Primary: Genetic problems with proliferation of mast cells called Mastocytosis. 1 in 10,000 people are born with this and it is diagnosed with KIT mutation and bone marrow biopsy. 

2. Secondary: Mast cells are normal in amount and function but are over-active in responding to external factors, such as environmental allergies, physically induced hives, and due to inflammatory or neoplastic conditions.

3. Idiopathic: No cause for mast cell activation can be uncovered--but the patient still suffers from anaphylaxis, hives, swelling, and MCAS. 

Where are mast cells found? They are present all over the body but are higher in skin, mucous areas of the intestinal and respiratory tracts, and where the outside environmental meets the body. 

Mast cells are part of our immune system and are designed to help protect us against irritants. Mast cells produce many substances stored in granules that are released when the cell is triggered: tryptase, histamine, cytokines, etc. These substances are what produce the signs and symptoms. Tryptase is the most specific mast cell mediator and we can test for tryptase to see if a patient has MCAS. 

MCAS causes many more problems that just runny nose and itchy eyes. It can affect nearly all body systems: 

1. Cardiovascular: High blood pressure, fainting, light-headedness, tachycardia

2. Skin: Flushing, hives, itching, swelling

3. Digestive: Cramps, diarrhea, Esophageal reflux, nausea and vomiting

4. Musculoskeleta: Aching, bone pain, arthritis, fibromyalgia, osteopenia and osteoporosis

5. Neurologic: Anxiety and depression, mood changes, vertigo, Insomnia, migraines, focus and concentration problems

6. Respiratory: Nasal congestion/itching/sneezing, asthma/wheezing, throat swelling

7. Reproductive/Urinary: dysmenorrhea, frequency/urgency urination, painful urination

8. Systemic: fatigue, weight loss

Histamine release is one of the main causes of all those symptoms above. The vast majority of patients have Histamine Intolerance vs. actual MCAS. Around 1% of the population has this and it's due to too much histamine in the body--too much occurs vs. how much the body is breaking it down. Nonetheless, symptoms and signs can still be significantly problematic. 

We can accumulate histamine from: creating it ourselves from our own mast cells, eating foods containing a lot of histamine, eating foods that help histamine be released inside us. 

We can have problems degrading histamine due to: enzyme deficiency of DAO (diamine oxidase), HNMT enzyme deficiency, blocking of those enzymes from being active. 

What foods are high in histamines? 

1. Fermented or microbially-ripended foods: Kombucha, sauerkraut, wine, vinegar

2. Aged cheese

3. Sausages and other processed meats: canned, cured, marinated, smoked

4. Many vegetables

5. Many fruit

6. Others: cocoa (chocolate), carob, soy milk, nettle tea (ironically used as a tea for allergies). 

Check out this website link for a very good list of all types of histamine promoting foods:  Histamine Elimination Diet

Histamine treatment consists of a multifactorial program of care. For diagnosis, which isn't perfect, there are things to investigate: 

1. Food sensitivity test

2. Diet diary

3. Gut microbiome: stool test, SIBO test, fungal analysis, sulphur intolerance

4. Environmental toxins: mold exposure/toxicity, chemicals, toxic metals

5. POTS work-up

6. Labwork: histamine and baseline and after eating tryptase

7. Genetic SNP testing

8. Good description of signs and symptoms

The chief diets for MCAS and histamine intolerance is a low histamine diet, low FODMAP Diet (which is not healthy long-term), avoiding food sensitivities, tidying up diet to be healthy and clean. It is important to not eat leftovers, as histamine increases in food as it ages. Leftovers that are frozen will have less histamine accumulation in them. 

Various nutrients can help reduce histamine release: B vitamins, Vitamin C, bioflavinoids, magnesium, copper. 

There are drugs that are used: 

1. H1 blockers: cetirizine, loratadine, fexofenadine, hydroxyzine

2. H2 bockers: famotidine

3. Leukotriene antagonists: monteleukast (Singulair)

4. Immune suppressants: rarely used and only when nothing is helping to reduce flares in MCAS)

5. Inhaled or orally ingested glucocorticosteroids: Budesonide, dexamethasone

Some more commonly used medications by Dr. Morstein include: cromolyn sodium (mast cell stabilizer), ketotifen (mast cell stabilizer and H1 blocker), and low dose naltrexone. 

Dr. Morstein's favorite supplements include Vit C/Quercitin mix, cur cumin, NAC, NAC, multiple vitamin mineral, Vit D3, fish oils, antioxidants. DAO enzyme is a supplement that is expensive and very rarely successful. Dr. Morstein doesn't recommend it often. 

Mast Cell and, more commonly, histamine intolerance are growing conditions world-wide. Dr. Morstein regularly sees and treats these complex and complicated conditions. Stabilization and healing can occur with them under good care.