Essential System 5: Identify and manage MCAS (Mast Cell Activation Syndrome)

MCAS is a type of mast cell activation disorder (MCAD) characterised by abnormal activation of mast cells resulting in chronic multisystem poly-morbidity of a general inflammatory nature, with or without an allergic nature.

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. The symptoms of MCAS will wax and wane over time. 

Another way to think of this is the symptoms will flare up and go into remission, affecting different organs and body parts, over and over again throughout a person’s life, without a common unifying theme or established diagnoses to account for the patient’s presentation of symptoms. 

MCAS symptoms can present subtly but may become more serious as an individual ages. If you were to chart the symptoms of MCAS on a timeline, beginning at birth you can often identify symptoms that began at a very young age.  

For some, MCAS becomes a highly probable diagnosis when they notice that they have had various symptoms of an inflammatory nature over the years. 


Treating Mast Cell Activation Syndrome (MCAS) 

Mast Cell Activation Syndrome (MCAS) is a group of disorders with different causes, presenting with episodic (sporadic) multi-system symptoms. 

MCAS is usually the result of mast cell mediator release, which often isn’t caught by routine lab tests. 


These symptoms may include: 

  • Allergies as a toddler 
  • Various skin rashes that came and went 
  • Disturbed gut function (possibly diagnosed as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), or small intestinal bacterial overgrowth (SIBO)) 
  • Unexplained anxiety 
  • Headaches 
  • Insomnia 
  • Poor wound healing 

Any of these symptoms could indicate MCAS. 

Frequently Asked Questions

Mast cells are types of white blood cells that release up to 200 signaling 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.  

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. 

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. 

Here are 7 Common Root Causes in Mast Cell Activation Syndrome: 

  • Food Triggers (beyond just histamine) or 
  • Infections and Toxicity 
  • Genetic Factors (like detox and inflammation issues) 
  • Nutritional Deficiencies 
  • Hypoxia (low oxygen)Sleep Apnoea or UARS 
  • Hormone Imbalances 
  • Stress and/or Early Trauma. Adverse Childhood Events (ACE) 

Mast cells are white blood cells that are concentrated at the entrances to body tissues/mucosal surfaces and are located throughout your body in many different tissues, primarily including dermatological/Skin, gastrointestinal tract, neurological (meninges of the central nervous system), and respiratory tissues (ears, nose, throat, lungs) and genitalia. 

While we need mast cells to protect us from threats, they become a problem when they are overactive and hyper-responsive and will not ‘turn off'. 

In the skin, mast cell numbers are highest in the upper dermis and their numbers are not affected by age or sex but increase in response to various environmental stimuli as shown after ultraviolet radiation in human skin and after exposure to topical sensitizing agents. It is thus obvious that mast cells constitute an inherent component of itch and numerous skin conditions.  

When these hyper-responsive Mast Cells are activated, they release over 200 signaling chemicals (e.g. histamine, prostaglandins, leukotrienes, cytokines and chemokines) which cause INFLAMMATION.

  • Melasma/hormonal pigmentation 
  • Chronic Dermatitis/Eczema 
  • Rosacea 
  • Psoriasis 
  • Urticaria  

Mast cells could be triggered in response to the inflammatory/high histamine foods, sun tanning, sun beds, steam rooms, saunas, toxins, heavy metals, pesticides, toxic mould, chronic infections (tick bite and viruses) or chemicals resulting in a range of chronic skin conditions such as urticaria (hives) eczema, Melasma. 

Emotional stress is associated with the activation of a variety of neuro-immune-endocrine systems. Numerous other factors are activated in stress, such as α-MSH, (Melanocyte Stimulating Hormone ) which increases and causes pigmentation. 

For example, the hypothalamic-pituitary-adrenal (HPA) axis is also activated and stress hormones are released. Furthermore, numerous other factors are activated in stress, such as α-MSH, neuropeptides, neurotrophins and the sympathetic nervous system.  

Additional symptoms such as gut problems (bloating, reflux, IBS) or insomnia (high histamine levels awake one from sleep at approximately 3 am). Any condition ending in “itis” eg osteoarthr“itis” could be due to MCAS.

In some people significant life stressors, which may be either physical or psychological in nature (divorce, bankruptcy, loss of job, travel, infection, death of a loved one, exposure to novel infections, occupying a water-damaged building, exposure to cold or heat). 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. 

MCAS can lead to widespread symptoms in many different body organs and systems including Melasma. A complex, chronic disease process. Symptoms can also wax and wane.  

Dr Lawrence Afrin, a leading mast cell researcher, believes that between 15 and 20% of the North American population may be affected by MCAS. The symptoms of MCAS vary greatly. As a result, many people spend years, even decades, in search of a correct diagnosis, visiting many different subspecialists. What is more frustrating for patients is that many doctors are not familiar with the multiple ways in which MCAS may manifest. 

  • Feeling as though you have been sick forever 
  • The trouble with allergies and asthma 
  • Overreaction to insect bites, bee stings and chemical intolerances 
  • Facial and chest flushing 
  • Skin rashes that come and go, including hives and angioedema 
  • Skin conditions such as eczema dermatitis, rosacea and melasma /hormonal pigmentation 
  • Itchiness and a burning feeling 
  • Brain fog and headaches/ migraines 
  • Insomnia is specially waking up at 3 AM (due to high histamine levels) 
  • Poor wound healing and easy bruising 
  • Waxing and waning of symptoms 
  • Ear problems such as Eustachian tube dysfunction, tinnitus 
  • Feeling of Vibration in body/restless leg syndrome 
  • CIRS Chronic Inflammatory Response Syndrome  
Sharon Izak Elaine Chat staff ) WhatsApp
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