Mast Cell Activation Syndrome & Lyme.

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Mast Cell Activation Syndrome in a Lyme disease treatment image from Marty Ross MD

What is Mast Cell Activation Syndrome?

Mast cells are immune system cells found throughout the body. In the past, in medicine we thought they were only turned on to release histamines in allergic reactions. However we now know that they are turned on by a host of things like:

  • Lyme and other bacteria,
  • things that trigger allergies called allergens,
  • inflammation chemicals called cytokines,
  • drugs,
  • molds and fungae,
  • proteins,
  • toxins,
  • stress through an adrenal gland stimulating chemical called corticotropin releasing hormone (CRH),
  • and viruses.

Marty Ross Discusses Mast Cell Activation Syndrome 

This video was recorded on 12/12/18 during our FREE Lyme Q&A Webinar called Conversations with Marty Ross MD.

 
 
 
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When Mast Cells become too turned on a person can have Mast Cell Activation Syndrome (MCAS). The chemicals released by activated mast cells include:

  • histamines,
  • inflammatory cytokines, prostaglandins and chemokines,
  • neurotransmitters like serotonin,
  • vasoactive chemicals like renin, and
  • hormone stimulators like VIP and CRH.

These mast cell chemicals effect many major organ systems in the body. So MCAS triggers an illness that can often look like other illnesses. And in some ways, like Lyme, it is a great masquerader.

Symptoms of Mast Cell Activation Syndrome

The symptoms of MCAS are due to the release of chemicals by activated mast cells. The symptoms of MCAS can include:

Body wide: fatigue, malaise, weight loss

Respiratory: nasal congestion, nasal itching, shortness of breath, throat swelling, wheezing

Neurologic: anxiety, depression, poor focus and memory, insomnia, migraines

Musculoskeletal: aches, bone pain, osteopenia, osteoporosis

Digestive: abdominal cramps, diarrhea, heart burn and reflux, nausea, vomiting

Skin: flushing, itching, hives, swelling of the skin

Cardiovascular: low blood pressure, fainting or near fainting, light headedness, racing heart.

Becoming More Allergic in Lyme

Many people with Lyme are allergic and reactive to many things in their environments. And for many with Lyme, this reactivity worsens during treatment. Lyme stimulates a variety of white blood cells including mast cells and T cells that attack Lyme to make cytokines. But research by Talkington and Nickell also shows when Lyme stimulates mast cells, it causes them to degranulate and release their histamines more easily. Degranulation and releasing of histamines is what happens in an allergic reaction when a person is exposed to an allergen like peanuts or pollens. But it now appears Lyme makes this whole process occur even when an allergen is not present. It might be possible that Lyme is turning on mast cells to be more sensitive to any and all allergens. 

Tests are Poor

There are a number of tests for MCAS, but generally they are very poor at identifying the illness. Blood tests include tryptase, histamine, prostaglandin D2 (PGD2), and heparin. There is also a urine test for PGD2 and n-methylhistamine. The best chance that these tests will be elevated is near the time someone is have an allergic reaction or when their allergic condition like asthma is active. PGD2 and heparin are very unstable, and break down easily so they must go to the lab chilled on ice after they are collected.

Do You Have MCAS?

MCAS is always a clinical diagnosis considering the signs and symptoms of the illness like allergy type symptoms and conditions, tests, and response to treatment. Because tests are very poor, I do not routinely do them in my practice and rely more on the signs and symptoms of someone being very allergic and improving with treatment.

Treatments for Mast Cell Activation Syndrome

1. Decrease Stress

Stress causes the brain to release CRH. CRH turns on the adrenal glands to help the body deal with stress. But CRH is a very strong stimulator of mast cells. Remove emotional toxins in your life and consider counseling, meditation, and exercise that help the body deal with stress.

2. Remove Allergens

If you have symptoms of allergies like runny nose, hives, asthma reaction, itching try to identify those things that trigger the reaction in your environment and with food. You may need the help of an allergist to identify these. For food, one way is to have your physician test for IGE antibodies against various foods. The immune system makes IGE antibodies against foods a person is allergic too. IGE antibodies bind to parts of the food a person is allergic too and then attach to the mast cells causing then to release histamines. If you cannot find a physician to help you, consider doing a food elimination diet that will help you identify foods you are allergic or sensitive to in any way. For more information see: Elimination Diet to Find Problem Foods. This article provides an elimination diet.

3. Treat Infections

As noted above, Lyme and other infections turn on mast cells. For information to help you figure out what infections you have see articles in How to Diagnose. And for treatment plans see articles in Infection Treatment Plans.

Pay particular attention to yeast overgrowth in your intestines.Yeast trigger excessive histamine release from mast cells lining the intestines. Read more articles on diagnosing and treating this problem in Yeast.

4. Remove Toxins

These toxins include chemical and even mold toxins. Two areas to consider in Lyme disease include MTHFR detoxification defects and Mold Toxin Illness. For more information see articles in Detoxification.

5. Lower Cytokines

As noted above, MCAS triggers the release of many chemicals by mast cells. One group of these are called cyotokines. Cytokines are responsible for many Lyme disease symtpoms. In excess they cause immune suppression. As a starting point use the supplement:

  • Liposomal Curcumin 500mg 1 pill 3 times a day.

You can also find other ways to lower cytokines in Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System.

6. Block Histamines and Allergic Inflammation

Histamines released by mast cells attach to a number of different histamine receptors. The two major ones are H1 and H2 receptors.

  • Antihistamines for H1 Receptors. Histamines attached to H1 receptors give most of the classic allergy symptoms like hives, itching, and runny noses. So if a person has symptoms related to H1 receptors use H1 receptor blockers like: Benadryl, Zyrtec, Allegra, and Claritin.
  • Antihistamines for H2 Receptors. H2 receptors are primarily found in the stomach and intestines. Histamines that attach to H2 receptors give intestinal symptoms like nausea, diarrhea and abdominal pain.  If a person has symptoms related to H2 receptors then use H2 blockers like: Tagamet, Zantac, Prilosec, and Pepcid.
  • Leukotriene Inhibitors.To block inflammation in the airways and the nose use leukotriene inhibitors like: Singular and Accolate.

7. Stabilize Mast Cells

Stabilize mast cells so they do not release their chemicals. There are a number of supplements people use for this, but the two best ones are:

  • Quercetin 250mg 2 pills 2 or 3 times a day
  • Luteolin 100mg 1 pill 2 or three times a day.

I start with quercetin first, but in more difficult situations I add luteolin.

Another option is to use the prescription cromolyn sodium, but this works best only for GI symptoms. And the nasal spray form works best for nasal allergies. The problem with the oral form, is it is very expensive.

8. Try a Low Histamine Diet

According to the Institute for Functional Medicine in its Elimination Diet Comprehensive Guide:

"In general, foods to avoid on a low-histamine diet include: bananas, chocolate, strawberries, tomatoes, egg whites, pork, sauerkraut, cheeses, fermented soy products, sausage, spinach, ketchup, eggplant, alcoholic beverages, smoked meats, vinegars, and canned fish, coffee and tea, leftover meats along with certain food additives and preservatives such as tartrazine and other food colors, benzoates, BHA, and BHT."

Comment

When it comes to supplements or prescriptions, I start first with curcumin, quercetin and luteolin. These tend to have no side effects and work well. If they do not work, then I consider adding the antihistamines and leukotriene inhibitors.

And I cannot stress strongly enough the importance in this disorder of finding ways to remove and deal with stress.

References

  1. Theoharides, T. (2016). Mast Cell Activation. Lecture presented at ILADS annual meeting, Philadelphia.
  2. Theoharides, T., Valent, P., Akin, C., Mast Cells, Mastocytosis, and Related Disorders. N Engl J Med,373;2, 163-172.
  3. Talkington, J., & Nickell, S. P. (1999). Borrelia burgdorferi Spirochetes Induce Mast Cell  Activation and Cytokine Release. Infection and Immunity, 67(3), 1107–1115.
  4. Institute for Functional Medicine. Elimination Diet Comprehensive Guide. Version 6. IFM 2016.

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