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Mast Cell Activation Syndrome (MCAS) - Leonard Weinstock, MD (2021 Conference) (LDN, low dose naltrexone)
Mast cells are relatively large cells that live in the bone marrow as a precursor, and then when it's stimulated, it goes out into the periphery into the body to orchestrate normal healing, and determine how other inflammatory cells react. MCAS often is congenital. It's an epigenetic disorder that goes towards somatic changes in a line of mast cells. These aberrant mast cells are low at birth but increased with age, so people get worse over time.
Over 130 mediators have been identified coming from mast cells, eg histamine, and tryptase which is a protease, heparin, pro-inflammatory cytokines, leukotrienes permeability, vascular permeability, etc. and cause reasons why patients can present with 40 different symptoms. It's multisystemic. Sometimes it's triggered by one thing but not the same thing another time. It’s important to ask about symptoms of anaphylaxis throughout life
Generally, the more syndromes a patient might have (eg fibromyalgia, chronic fatigue, interstitial cystitis), the common denominator may be MCAS.
Dr. Weinstock begins with a case discussion of a patient with negative endoscopy done because of cyclic vomiting syndrome, but endoscopic biopsies showed excess mast cells. Prostaglandin D2 was elevated. Low dose naltrexone (LDN) and over the counter products gave full resolution
He talks of a cell mediator release syndrome questionnaire he uses to help diagnose mast cell activation, a precursor of MCAS, and how they are applied to help differentiate the components affecting the mediators and associated disorders, such Ehlers Danlos Syndrome. Environmental phenomenon will worsen MCAS, eg diet, atmosphere and/or electronic changes. autoimmune phenomenon, antibiotics, gut bacteria, SIBO. Sometimes, treating the associated phenomenon will improve MCAS symptoms.
He stresses the importance of diet, and knowing dietary triggers of mediator production and release. They may use cromolyn, or herbal products, omalizumab, low dose naltrexone in approaching MCAS therapy.
KEYWORDS: mast cells, mediators, histamine, mast cell activation syndrome (MCAS), hives, low dose naltrexone pain, fatigue, migraine, SIBO, restless legs syndrome (RLS), Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers Danlos Syndrome, autoimmune
This is a summary of the presentation. Watch the video for full information.