Mast Cell Activation Syndrome (MCAS)

Mast Cell Activation Syndrome (MCAS) occurs when a patient’s mast cells are working to fight off a foreign substance in the body by frequently overproducing mediators such as histamine, a hormone that causes allergy symptoms like inflammation. [76] Mast cells are a part of our immune system and are present in the connective tissue of our bodies. When your body is exposed to a trigger like an allergen, mold, infection, or an irritant, your mast cells react by producing mediators that cause symptoms of an allergic reaction. Mast cell activation syndrome (MCAS) occurs when too many mast cell derived mediators are released too often. [77] Mast cell activation syndrome (MCAS) is often associated with a wide variety of symptoms making it difficult to pinpoint. The symptoms of mast cell activation syndrome (MCAS) can range from mild headaches, urticaria, or abdominal cramping to severe or life-threatening anaphylaxis. [78] However, according to researchers, in order to be considered mast cell activation related, these symptoms need to be recurrent or permanent, unable to be explained by another condition, and require therapeutic intervention. [79] The type of therapy for patients with mast cell activation syndrome (MCAS) varies and often depends on the underlying disease, type of MCAS, and response to initial therapy.[80] In severe cases, particularly in patients with mixed mast cell activation syndrome (MCAS), a combination of treatments might be recommended by your prescriber. [81]

Compounding Options for Mast Cell Activation Syndrome (MCAS)

Ketotifen Oral Capsules and MCAS

It is often advised for mast cell activation syndrome (MCAS) patients to begin preventative anti-mediator therapy which can come in the form of a histamine receptor blocker.[82] One of the most common histamine receptor blockers and mast cell stabilizers for mast cell activation syndrome (MCAS) is ketotifen. Ketotifen relieves symptoms caused by the overproduction of histamines in the body by stabilizing the mast cell and inhibiting the release of its proinflammatory mediators.[83] Ketotifen oral capsules are not commercially available in the U.S. and must be compounded through a compounding pharmacy. When choosing a compounding pharmacy for your Ketotifen Capsules, it’s important to look for one that is knowledgeable about mast cell activation syndrome (MCAS). At Forte Rx Compounding Pharmacy, Ketotifen can be compounded into a capsule form with the highest quality capsule shells, free of any preservatives and dyes MCAS patients may have sensitivities to.

Cromolyn Sodium and MCAS

Cromolyn Sodium is a mast cell stabilizer that prevents the release of inflammatory mediators in the body when exposed to reactive allergens. [84] Originally developed as a treatment for asthma symptoms by Dr. Roger Altounyan, Cromolyn Sodium is a commonly prescribed medication for patients with mastocytosis. Cromolyn Sodium works by inhibiting the immediate and late release of mast cells which can improve symptoms such as urticaria, nausea, diarrhea, vomiting, headaches, and itching for patients with MCAS. Cromolyn Sodium can be compounded into capsule form.

LDN and MCAS

In a clinical trial, low dose naltrexone was shown to improve MCAS symptoms such as reducing neuroinflammatory pain, body pain, GI symptoms, and fatigue. [84] The benefits of LDN for MCAS extends to blocking Toll receptors that stimulate mast cell activity, regulating overall T-lymphocyte production, and decreasing cytokine mediators from T cells that directly cause mast cell activation.

Please contact our clinical department today at (805) 427-9053 and ask to speak with one of our expert chronic inflammatory response syndrome (CIRS), mold/biotoxin illness, and Lyme Disease clinical pharmacists about Mast Cell Activation Syndrome (MCAS).

^[76] Moyer, N., & Klein, E. (2021, October 1). Mast Cell Activation Syndrome (MCAS): Symptoms and Treatment. Healthline. Retrieved from https://www.healthline.com/health/mast-cell-activation-syndrome

^[77] Moyer, N., & Klein, E. (2021, October 1) https://www.healthline.com/health/mast-cell-activation-syndrome

^[78] Valent, P., Akin, C., Nedoszytko, B., Bonadonna, P., Hartmann, K., Niedoszytko, M., Brockow, K., Siebenhaar, F., Triggiani, M., Arock, M., Romantowski, J., Górska, A., Schwartz, L. B., & Metcalfe, D. D. (2020). Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine. International journal of molecular sciences, 21(23), 9030. https://doi.org/10.3390/ijms21239030

^[79] Valent, P., Akin, C., Arock, M., Brockow, K., Butterfield, J. H., Carter, M. C., Castells, M., Escribano, L., Hartmann, K., Lieberman, P., Nedoszytko, B., Orfao, A., Schwartz, L. B., Sotlar, K., Sperr, W. R., Triggiani, M., Valenta, R., Horny, H. P., & Metcalfe, D. D. (2012). Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: a consensus proposal. International archives of allergy and immunology, 157(3), 215–225. https://doi.org/10.1159/000328760

^[80] Valent, P., Akin, C., Nedoszytko, B., Bonadonna, P., Hartmann, K., Niedoszytko, M., Brockow, K., Siebenhaar, F., Triggiani, M., Arock, M., Romantowski, J., Górska, A., Schwartz, L. B., & Metcalfe, D. D. (2020). Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine. International journal of molecular sciences, 21(23), 9030. https://doi.org/10.3390/ijms21239030

^[81] Valent, P., Akin, C., Nedoszytko, B., Bonadonna, P., Hartmann, K., Niedoszytko, M., Brockow, K., Siebenhaar, F., Triggiani, M., Arock, M., Romantowski, J., Górska, A., Schwartz, L. B., & Metcalfe, D. D. (2020). Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine. https://doi.org/10.3390/ijms21239030

^[82] Valent, P., Akin, C., Nedoszytko, B., Bonadonna, P., Hartmann, K., Niedoszytko, M., Brockow, K., Siebenhaar, F., Triggiani, M., Arock, M., Romantowski, J., Górska, A., Schwartz, L. B., & Metcalfe, D. D. (2020). Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine.https://doi.org/10.3390/ijms21239030

^[83] Sokol, K. C., Amar, N. K., Starkey, J., & Grant, J. A. (2013). Ketotifen in the management of chronic urticaria: resurrection of an old drug. https://doi.org/10.1016/j.anai.2013.10.003

^[84] Minutello K, Gupta V. Cromolyn Sodium. [Updated 2022 Jan 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557473/

^[85] Weinstock, L. B., Brook, J. B., Myers, T. L., & Goodman, B. (2018). Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment. BMJ case reports, 2018, bcr2017221405. https://doi.org/10.1136/bcr-2017-221405

Mast Cell Activation Syndrome (MCAS)