(mast cell activated coronary angina), postural orthostatic tachy- cardia syndrome, atopic dermatitis, autoimmune disease, drug allergy, chronic fatigue, depression, intractable migraine, rage (explosive disorder), chronic uticaria, rosacea, exercise induced anaphylaxis, autism, some seizure disorders, female sexual dys- function, polycythemia, and Ehlers-Danlos syndrome.
Signs and symptoms of mast cell disorders include the following:
• Fatigue and weakness • Fever • Environmental sensitivities • Weight loss or obesity • Light headedness/faintness • Anaphylaxis • Diffi culty focusing • Sinusitis and rhinitis • Canker sores • Burning mouth pain • Cough, wheezing, loss of breath • Increased mucus production • Tachycardia (fast heart beat) • Hypotensive episodes (very low blood pressure) • Non-cardiac chest pain • Coronary artery vasospasm • Diarrhea • Abdominal pain • Nausea with or without vomiting • Acid refl ux • Malabsorption • Cramping and bloating • Enlargement of the liver or spleen • Bladder pain • Bone and muscle pain • Itching, rashes and hives • Flushing • Dermatographia (when the skin is lightly scratched, raised wheals, similar to hives, appear) • Angioedema • Depression, anxiety, and brain fog
Diagnosis and Treatment
MCAS is quite diffi cult to diagnose as it is not generally found with routine laboratory or radiologic testing. For this reason, pa- tients are often dismissed or prescribed antidepressants. Even if suspected by the practitioner it may be diffi cult to confi rm a MCAD diagnosis. Markers that may help with diagnosis include serum tryptase, serum chromogranin A, plasma heparin, Urinary N-methylhistamine, urinary prostaglandin D2, and urinary leu- kotriene E4. For this reason, many practitioners will diagnose the disorder if two or more symptoms are present with or without cor- relating lab tests. The key player in diagnosis is whether or not the treatment is effective.
Ironically, this seemingly complicated disorder has a surpris- ingly simple treatment plan. H1-blockers like Zyrtec, Claritin, and Allegra, and H2-blockers such as Pepcid or Zantac are the primary medications used for this disorder and they are readily available over-the-counter. Many patients also require Singulair, a leukotriene inhibitor (prescription only) and a mast cell stabilizer such as the prescription Chromolyn Sodium or the supplement
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