What is Mast Cell Activation Syndrome (MCAS)?

Updated: Aug 12


Mast cells are immune cells that release histamine and are involved in allergic reactions. They are absolutely necessary to our immune system, but can overreact when triggered by stressors including infections and inflammation. Mast cells have the highest concentration in the areas of our body that interact with the outside world: our skin, lungs and digestive system.


Mast cells are patrolling for inflammatory external offenders and create inflammation to help protect us. Mast cell overactivation in response to stressors including infections and stress can contribute to chronic and uncomfortable symptoms:


Symptoms of Mast Cell Activation Syndrome and/or histamine intolerance are multi-systemic and can include:

  • Anxiety

  • Blood sugar instability (a.k.a. Hangry)

  • Depression

  • Extreme reactions to insect bites

  • Fatigue

  • Gastrointestinal Issues like abdominal pain, diarrhea, bloating, nausea, vomiting

  • Headaches

  • Head pressure

  • Heart palpitations

  • Hives

  • Joint and muscle pain

  • Lightheadedness with standing

  • Nasal congestion

  • Pain with urination

  • Skin itching

  • Urinary frequency

Conditions Mast Cell Activation Syndrome may be related to include:

  • Allergies

  • Asthma

  • Chronic Hives

  • Chronic Inflammatory Response Syndrome

  • Crohn’s disease and Ulcerative Colitis

  • Fibromyalgia

  • Gastroesophageal Reflux (GERD)

  • Hypermobility Syndromes like Ehlers Danlos Syndrome

  • Interstitial Cystitis

  • Migraines

  • Leaky Gut Syndrome


Treatment for MCAS

While we do not currently know all of the causes for MCAS, there are effective ways of controlling it. Reducing and aggressively managing the inflammation involved in MCAS is a critical first step before treating chronic infections. Bringing down environmental (e.g. inflammation from food) helps to open the doors to the proper treatment of infections and infectious triggers of MCAS.


Low Histamine Diet

In our practice, we get the best results when a MCAS patient addresses their dietary triggers prior to incorporating any stabilizing medications or supplements. The diet helps to drive down the inflammation initially to allow the stabilizers to be more effective. If you would like more information from our in-office study, please see the full presentation under the “Media” tab.


If you want the cliff notes, we found that implementing diet before stabilizers brought down inflammation about 38% and stabilizers with diet only brought down inflammation 10%.


As my mentor put it so nicely -- If you are in the shower with the water running and you ask for a towel, you struggle to actually get dry. If you first turn off the water, you can effectively use the towel. The water is analogous to the environmental triggers that drive the inflammation including your diet.


Dietary intervention is the first essential step where one would eliminate:

  • High histamine foods

  • Avoid leftovers (easier than you think)

  • Avoid fermented foods like sauerkraut, kim-chi, yogurt and kombucha


Mast Cell Stabilizers

After several weeks of dietary management, one may add one or more of several mast cell stabilizers to help to continue to drive down the inflammation.


There are both natural and pharmaceutical interventions that can help to reduce histamine in the body.


Some examples of natural antihistamines include Quercetin, Holy Basil, Turmeric and probiotic strains that reduce histamine levels.


Some examples of pharmaceutical antihistamines include Benadryl (sedating), Claritin, Zyrtec, Ketotifen and Cromolyn Sodium.


Mast Cell Drivers

Though diet and mast cell stabilizers can manage MCAS symptoms, they still don’t address the driving force behind the condition.


As we continue to learn more, we are finding various factors drive this exaggerated immune response including:

  • Exposure to Water Damaged Buildings/Mold and Mycotoxins

  • Exposure and Sensitivity to EMFs

  • Emotional Stress and Trauma

  • Chronic infections including Parasites and Viruses

  • Environmental Toxins and Heavy Metals

In our treatment of Mold, Lyme and PANDAS/PANS patients, evaluation and treatment of MCAS has become a cornerstone for proper treatment. Once the inflammation has been contained, we are able to implement successful protocols with greater ease.

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