What MOST PEOPLE DON'T KNOW About MCAS | Mast Cell Activation Syndrome Causes, Symptoms, & Treatment
Dr. A explains mast cell activation syndrome as chronic over-activity of immune cells that causes severe allergic reactions and widespread inflammation, often triggered by infections like long COVID or Lyme disease, gut dysfunction, toxins, or genetic factors. Standard treatment with antihistamines rarely works because it ignores these underlying drivers. He outlines a diagnostic approach starting with basic labs, then testing for infections, mold exposure, and heavy metals if needed.
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This is one of those areas where people will lose patience. Usually by the time a person seeks help, they've already been frustrated, and it's very difficult. It doesn't change overnight. Certainly you can give a person enough steroids to get them out of trouble, or you can give them mast cell stabilizing drugs. Really, you got to work on all these other things that are feeding into it. Hey, I'm Dr. A. I've been researching and teaching in the integrative and naturopathic medical community for 30 years now, and I've been seeing patients during that time, I use this channel to answer questions that we get. So this topic today is one of those, and it's understanding and kind of getting at the ground floor of mast cell activation syndrome, also known as mast cell disorder. So first off, if this is a new idea to you, mast cell activation syndrome is a constellation of medical symptoms, problems that occur due to the activation of a group of cells. Now, The famous ones are mast cells. These are granular immune cells, and inside the granules, there's inflammatory mediators like histamine and heparin and all sorts of other stuff. But the first thing we want to understand is that the mast cells have the name of the disorder, but there's 3 other groups of cells that are also responsible. There's things like eosinophils and basophils and CD40 cells and You know, there's a whole bunch of stuff going on in the cell biology of mast cell disorder. So the first thing is, yes, mast cells pull a lot of the weight with the disorder, but it's not just them. It's their family. Okay. We call it the quartet. The next thing that we want to kind of look at at the ground floor is if these things make me sick, why are they there? We see a lot of things to stop inflammation, anti-inflammatory drugs, steroids, stuff like that. Right. And so you think, well, why does the human body have inflammation? Well, if human body has inflammation, Because if we didn't have inflammatory pathways, we would be dead. We would never trigger an immune response, et cetera. Well, the mast cell quartet, all of those different types of cells with the mast cell sort of as the leader there, their degranulation is supposed to happen to help us incite an immune and potentially repairing event in the body. Just like inflammation's important, but if I do too much of it, it becomes a problem and I have pain and stuff. Mast cell and granular cell degranulation is important, And it keeps me alive. But if I'm always doing it, and I'm always hyper degranulating and sending these inflammatory chemicals out, that person's going to be sick all of the time. That's when you have mast cell disorders. And mast cell activation syndrome is a way to characterize a group of problems that come on because what we found over the decades is we used to just think that there is a disease called mastocytosis. There's cancer related, and there's some other bad things. And we thought that's all the mast cell disorders that there. There were. And then what we found out is a lot of people that have allergic phenomena and other things that go on have a constellation of mast cell activation problems. And so the idea of calling it mast cell activation syndrome is probably the most realistic characterization of that disorder. Now, some people shorten it to MCD, mast cell disorders, kind of the same idea. But what happens when I get too much mast cell degranulation? Well, what happens is it's like having a couple of big problems at the same The first one is allergic phenomenon. People can have very aggressive allergic reactions. They can have anaphylactic reactions. They can have respiratory, skin, joint, all sorts of allergic phenomenon. And then the other thing is, is that it causes so much inflammation in the body that other processes get disordered. Now, we have talked about the combination of disorders that sometimes collect together. And so when we look at mast cell activation syndrome, Patients sometimes that's their main problem that they have. Sometimes they also get dysautonomias like POTS. That can also happen alongside, and there's other things that can go on too. You can look at our video on the evil triad, and it goes into that. So mast cell can present in different ways because we all have different ways of responding to the mast cells misbehaving, if you will, and it can be treated in different ways in different people. But one of the other things that becomes maybe a little muddier, and because I do. Physician education around mast cell disorders, et cetera, I often see this as, you know, you have to sort of relearn your idea of allergy and immunology and all of that in order to deal with mast cell as a clinical entity. So it's not just about mast cell and granular cell degranulation. If it was, then the drugs or treatments that we use to treat, like antihistamines and steroids, would stop all of the problems. The problem we have with that is most people with aggressive mast cell activation syndrome, those things might keep them from dying or keep them from getting really sick, but they're still having all these reactions. So obviously, if it was just the mast cells, it wouldn't just be that way. So the next thing that gets misunderstood is there's lots of pathways into triggering mast cells and making them more hyperreactive. So what are those things? Well, they can be all over the map. So when we're assessing, looking at a mast cell patient, we have to look at all of these factors that feed in. So one of the factors would be chronic or latent infections. Now, in recent history, if you're listening to this in 2024 or 2025, we've had COVID. Now there's long COVID. A lot of people in long COVID develop mast cell sensitivity, mast cell activation. Well, it's the same with Epstein-Barr. It's the same with Lyme complex. It's the same with many, many other chronic infectious illnesses. So infectious disease is one. The next area that that is a huge trigger for mast cell is digestive tract, either immune or neurological or microbiome or all of the above imbalance. So the digestive tract, and what's weird is even with no gut symptoms, no digestive symptoms, you can have these things go on where the microbiome is thrown off or the GI immune system thrown off, the GI nervous system or all 3. And then that increases the amount of mast cell sensitization through a whole bunch of network things that go on. Another thing that's really common is exposure or sensitivity to toxins and toxicants. So what does that mean? Well, you might have a direct toxin like a mycotoxin, a mold toxin, another common comorbidity collateral disorder along with mast cell activation. You might have chemical toxicity you've been exposed to. You might have metal toxicity or other toxicities you've been exposed to. So those are other ones that feed into the aggravation of mast cell disorder. The other thing that we see is if your hormonal system, the endocrine system, is out of balance, that can aggravate mast cell disorders just like all of these other things. And there's genetic things, there's other stuff. So one of the most misunderstood things is that it's just these mast cells. If we could just contain these mast cells, mast cell activation syndrome would go away sometimes, but usually it's the tip of the iceberg and there's this stuff underneath. Now, some people have one problem underneath, some people have all of them, and the people who've had more mast cell activation have more problems. There's more of these subproblems that are feeding into it. So it's a very frustrating problem for people to deal with because often they may go to primary care and they may get antihistamines or steroids, and that helps a little bit. Maybe they react to some of that stuff because they're already hyperreactive, but they don't really get worked up, you know, with the other things that we just talked about to be looked at. A lot of times they'll go to the allergist, a specialist like an allergist, and in the allergy immunology community, mast cell disorders are known about, but they are In the modern way of training in the allergy immunology specialty, they're considered very rare, and indeed they are not rare. So you kind of have this collision of kind of the training you got as a specialist and the reality that's in the world, and they're not very close together. So some allergy immunology docs are all about mast cell, and and many of them are just like well that doesn't happen that often. They would give you similar drugs to what primary care would give you. So as far as managing it, the first thing is. You might have to really do some of your own self-education. That's why we do these things. There's a lot of other really good people who have dealt with it themselves, who have videos that you can look at. You may have to kind of build a team. So maybe the primary care doctor is really great and they're willing to do whatever to help, but they haven't, you know, looked into, you know, a lot of the deeper treatments or assessments. So you may have to bring them ideas or things. Could you check these things out? You may sometimes need the primary care doctor and an integrative provider or some combination thereof. To work on these things, because it is a lot when when you have one person who's hypersensitized and they're very at the aggravated end of mast cell disorder, mast cell activation syndrome. There's a lot of things to juggle while you're treating the patient. So sometimes it's more than one provider. You being educated, it's getting help in that way. The tenets are often finding the triggers and lowering or removing them. So that's not just allergy triggers, but those are certainly important. But it's also all of the other things that disorder your immune system. So probably looking at your GI microbiome, getting your GI tested for bugs that shouldn't be there, etc. Looking at mold toxicity testing and maybe chemical and metal toxicity testing. Looking at chronic infections, testing them, treating them, that sort of thing. So you kind of have to work on all those things. And what I usually tell patients in the approach is, if you are just starting and I just see you and you have what appears to be mast cell problems, we're going to check Check the most likely things. We're going to look at your production of your B cells for immunoglobulins and subfractions of immunoglobulins. We're going to look at your basic labs to see if everything's functioning there. We're going to look at inflammatory markers, of which there's a whole bunch, and then we might do some allergy testing. We might do some other testing. So there's a core. If we work on that stuff and you start to get a lot better, then we don't have to dig deeper. If we work on that stuff and you get a little bit better, but you're still reacting, then we might have to take a step back and look at chronic. Infectious disease panels looking for chronic infections. As I said, we might want to look for mycotoxins from mold and other toxins, the gut testing, whatever it is. So you kind of keep testing deeper until you find enough things to treat and address to help decrease the sensitivity. All right. I'm Dr. A. This is the YouTube channel. I know that was a little bit of a rough one, but I tried to answer the questions that came up around mast cell and triggers. And we really appreciate all of you new subscribers. We appreciate all you base subscribers who got us where we are. We love answering questions. On here, please do like, share, subscribe, do the notifications, and I'll see you guys on the next video.
