Mast Cell Activation Syndrome (MCAS)

What is MCAS?

Mast Cell Activation Syndrome is an abnormal immune response involving a subtype of white cells, called mast cells. These cells are located in connective tissue throughout the body, with higher concentrations near blood vessels and nerves, as well as at interfaces with the external environment, like the skin, lungs, and intestines. Mast cells act as guardians: when a virus or bacterium invades the body, they are activated and release around 1,200 different inflammatory chemicals, called mediators, such as histamine, prostaglandins, and cytokines, for example. In a study in Germany, 17% of the population was found to have MCAS (Molderings et al., 2013), so while uncommon, it is not a rare disorder.

What causes MCAS ?

The clearest known risk for MCAS is genetic (Castells et al., 2024) but environmental factors (like mould, Epstein-Barr, COVID, etc), and/or physical and psychological stressors can also trigger the condition (González-de-Olano, 2018). 

What are the symptoms of MCAS ?

Symptoms often include flushing, allergic-type issues, fatigue, hives, cognitive dysfunction, irritated eyes/nose/mouth/throat, lymph node inflammation, shortness of breath, palpitations, nausea, reflux, abdominal pain, diarrhea (often alternating with constipation), bladder pain syndrome, inflammation of the vagina, excessive or prolonged menstrual bleeding, painful menstrual cramps, fibromyalgia-type pain, joint hypermobility, benign growth anomalies (e.g. cysts, fibrosis, vascular anomalies, poor healing), headache, sensory neuropathy, dysautonomias (e.g. orthostatic hypotension, blood pressure and heart rate variability, thermal dysregulation), anxiety and mood disorders, insomnia, and an assortment of metabolic/endocrinologic (e.g. thyroid) abnormalities (Afrin et al, 2020).

How is MCAS diagnosed ?

Diagnosing MCAS is fraught with difficulty and controversy. For a full picture, see the Valent et al. and Afrin et al. papers referenced below. Dr. Bruce Hoffman’s and Tania Dempsey’s podcasts on the subject are also very helpful and are referenced below as well. If you suspect you have MCAS it is important that you seek a consultation with a doctor or immunologist who is familiar with the condition.

The link between trauma and MCAS:

The limbic system — which includes structures such as the amygdala, hippocampus, and hypothalamus — plays a central role in processing emotions, memories, and the body’s response to stress. Chronic or severe trauma can cause the limbic system to become hyper-reactive, interpreting even benign stimuli as threats. Mast cells have receptors for neuropeptides and stress hormones released by the limbic system. When the brain perceives danger, signals such as corticotropin-releasing hormone (CRH) and substance P can directly activate mast cells, prompting them to release inflammatory chemicals (Wirz & Molderings, 2017; Bhuiyan et al., 2021). In those with MCAS, this feedback loop can become dysregulated: trauma primes the limbic system to overreact, which in turn continually “triggers” mast cells (Frieri et al., 2015). This may explain why some patients experience symptom flares after emotional stress or in environments reminiscent of past trauma (Kempuraj et al., 2017). Therefore, addressing both the physical immune dysregulation and the energetic imprint of trauma becomes essential for long-term healing.

Homeopathic treatment of MCAS:

MCAS will express itself differently in every individual and therefore there is no one-size-fits-all remedy. However, the condition can be approached within a miasmatic framework. Being a dysregulated immune response, the corresponding miasms would be either syphilitic or sycotic or a combination of both (tubercular), so remedies within those realms might be worth having front of mind. Paying due attention to the event that triggered the condition will be important as well. An immune response is a defence mechanism so what stressor caused the body to go into hyper-alert ? If that stressor was emotional, such as a shock due to grief or fright, then this shock will have to be addressed before healing can occur. If the stressor is something like mould, then one might treat this isopathically, and focus on detoxification via organopathy, before prescribing on the totality of remaining symptoms, and then constitutionally (unless a miasm is blocking the way in which case this will have to be addressed beforehand). The choice of potency will also be important. When treating the miasm and psychological and emotional aetiologies, higher potencies would generally be appropriate. When treating a narrow set of purely physical symptoms (a "lesion layer"), an approach would be to administer repeated low-potency doses. It is important to remember that homeopathy is first and foremost an individualised health support system, and therefore the choice of remedies will always depend on what symptoms the patient is presenting.

A personal story:

A few years ago, during a routine yearly blood check, I was found to have Hashimoto’s disease (an autoimmune disorder affecting the Thyroid gland). My symptoms at the time were fatigue but otherwise I felt fine. After supplementing with Selenium and very low doses of iodine, I went into remission. Shortly afterwards, I became ill with shingles. Then, a few months later, I started experiencing headaches. Intermittent at first, they became permanent and were diagnosed as “chronic tension-type headache” and “New Daily Persistent Headache” by two different neurologists. One of the more prominent symptoms of these headaches was the sensation of pulling behind the eyes, as if my optic nerve had shortened. One 200c dose of Paris Quadrifolia eliminated that particular aspect of my headaches but the overarching sensation of living with a helmet that was three times too small remained. Some months later, I started suffering from severe insomnia and panic attacks. The panic attacks were cured by Aconite (one dose of 200c and then a few weeks later 30c every night before bed). However, the headaches and insomnia remained, and I spiralled into a very deep depression. After trialling four different anti-depressants (a very unpleasant experience), nothing had changed. At a particularly low point, I took one dose of Natrum Muriaticum 200c. The effect was immediate and palpable. I felt like a shield that no negative thought could penetrate had been erected around me. At this point, a friend of mine (to whom I owe a huge debt of gratitude) suggested getting tested for MCAS, which was diagnosed by an immunologist via a blood test measuring histamine levels and a 24-hour urine test. I was first prescribed over-the-counter anti-histamines, but did not find these to be of any help (which does not mean that they would not be of any help to someone else suffering from MCAS). I then started taking Sodium Cromoglycate, which alleviated some gastro-intestinal symptoms, but not the headaches or insomnia. At this time, I started seeing a homeopath who prescribed a 200c single dose of Medhorrinum, the impact of which I felt within 12 hours. I was still left with insomnia and headaches, but the headaches had diminished in intensity by about 50%. It was as if a layer of lead had been lifted off my head. Unfortunately, further doses of the remedy, in both the same and higher potency did not result in any further amelioration. About a year later, I was prescribed Pulsatilla, starting at 200c in ascending potency, which improved my vitality but did not cure the headaches or insomnia. There is a strong association between MCAS and Ehler-Danlos Syndrome, and I started to suspect that my headaches were due to cervical instability (head symptoms aggravated when sitting, lying on my back, and standing still, and ameliorated when lying prone). A dynamic x-ray revealed that my hunch was correct. Cervical instability being caused by a weakening of the cervical ligaments, I started taking Ruta in 12c potency three times a day, and ascending potencies of Syphilinum (200c to 10M) as an miasmatic remedy taken once a week. The headaches slightly improved but were not cured. Since then, I have become aware that my insomnia is directly related to the food that I consume and have therefore started a low-histamine diet, which, when I strictly adhere to it, has a positive effect on my sleep and headaches. Key takeaways from my experience are that homeopathy can provide powerful healing support even when dealing with complex conditions, and that MCAS is a multifaceted illness, the healing of which requires a multifaceted approach.

References:

Afrin, L. B., Ackerley, M. B., Bluestein, L. S., Brewer, J. H., Brook, J. B., Buchanan, A. D., ... & Dorff, S. R. Diagnosis of mast cell activation syndrome: A global “consensus-2”., 2020, 8. DOI: https://doi. org/10.1515/dx-2020-0005. PMID: https://www. ncbi. nlm. nih. gov/pubmed/32324159, 137-152

Bhuiyan, P., Wang, Y. W., Sha, H. H., Dong, H. Q., & Qian, Y. N. (2021). Neuroimmune connections between corticotropin-releasing hormone and mast cells: novel strategies for the treatment of neurodegenerative diseases. Neural regeneration research, 16(11), 2184-2197

Castells, M., Giannetti, M. P., Hamilton, M. J., Novak, P., Pozdnyakova, O., Nicoloro-SantaBarbara, J., ... & Milner, J. D. (2024). Mast cell activation syndrome: Current understanding and research needs. Journal of Allergy and Clinical Immunology, 154(2), 255-263.

Frieri, M., Kumar, K., & Boutin, A. (2015). Role of mast cells in trauma and neuroinflammation in allergy immunology. Annals of Allergy, Asthma & Immunology, 115(3), 172-177.

González-de-Olano, D., Domínguez-Ortega, J., & Sánchez-García, S. (2018). Mast Cell Activation Syndromes and Environmental Exposures. Current Treatment Options in Allergy, 5(1), 41-51.

Kempuraj, D., Selvakumar, G. P., Thangavel, R., Ahmed, M. E., Zaheer, S., Raikwar, S. P., ... & Zaheer, A. (2017). Mast cell activation in brain injury, stress, and post-traumatic stress disorder and Alzheimer's disease pathogenesis. Frontiers in neuroscience, 11, 703.

Molderings, G. J., Haenisch, B., Bogdanow, M., Fimmers, R., & Nöthen, M. M. (2013). Familial occurrence of systemic mast cell activation disease. PloS one, 8(9), e76241

Valent, P., Akin, C., Arock, M., Brockow, K., Butterfield, J. H., Carter, M. C., ... & Metcalfe, D. D. (2012). Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: a consensus proposal. International archives of allergy and immunology, 157(3), 215-225

Wirz, S., & Molderings, G. J. (2017). A practical guide for treatment of pain in patients with systemic mast cell activation disease. Pain Physician, 20(6), E84.

Podcasts:

Your Health. Your Story. Episode 201, 24 September 2024

Mast Cell Matters: Deep dives on MCAS with Tania Dempsey, MD

Useful Resources:

https://mastcell360.com/

https://www.youtube.com/watch?v=8wdVMvBfLCs (explanation of the progression from dysautonomia to MCAS and beyond)