Triggers of Mast Cell Activation

Mast Cell Activation Syndrome (MCAS) is a complex condition that affects individuals in a multitude of ways, leading to a myriad of symptoms that can significantly impact one's quality of life. At the core of managing MCAS is the identification and understanding of the various triggers that can initiate mast cell activation, leading to the release of numerous mediators responsible for the symptoms experienced by patients. This article delves into the known triggers of MCAS, providing insights that aim to assist patients and healthcare providers in navigating this challenging condition

The factors leading to mast cell activation in individuals may vary over time, indicating that a patient could suddenly become sensitive to a trigger that previously posed no issue, including various medications.

Mast Cell Activation Triggers

• Environmental Factors
  • Temperature shifts, including extreme heat or cold
  • Potent scents or fragrances
  • Skin friction (such as that caused by massage)
  • Vibrational forces
  • Electromagnetic frequencies
  • Presence of mold
  • Insect sting venom, particularly from hymenoptera like wasps, bees, hornets, and ants
  • Exposure to heavy metals
  • Sunlight exposure
• Dietary Influences
  • Any food or beverage could potentially trigger an episode
  • Histamine-rich foods such as aged cheeses, fermented products, and certain fish
  • Foods containing salicylates
  • Alcoholic beverages
  • Artificial additives, colors, and preservatives
  • It's crucial to identify specific dietary triggers through detailed food trials under medical supervision, as even foods with low histamine levels may cause reactions.
• Medications
  • Antibiotics, with Vancomycin highlighted as a significant trigger, should be used with caution
  • Opioids, NSAIDs, neuromuscular junction blocking agents, and local anesthetics
  • Aspirin may be beneficial or harmful, necessitating strict medical supervision during trials
• Pathogens
  • Infections from bacteria, viruses, parasites, and mycotoxins from mold
• Stress
  • Emotional, physical, and social stressors: Stress, whether emotional, physical, or even due to sleep disturbances, can significantly impact mast cell activity. Learning stress management techniques can be a crucial part of managing MCAS.
• Hormone fluctuations
  • Women with MCAS may notice a pattern in symptom fluctuation correlating with menstrual cycles, pregnancy, or menopause, suggesting that hormonal changes can influence mast cell behavior. Sometimes this is diagnosed as PMDD, but more often these symptoms are incorrectly dismissed by doctors as normal symptoms of PMS.

This list doesn't cover all possible triggers but highlights some common ones.

Conclusion

Understanding the triggers of Mast Cell Activation Syndrome is a fundamental step in managing the condition effectively. Since MCAS is highly individualistic, what triggers a reaction in one person may not affect another. It necessitates a personalized approach to care, emphasizing the importance of close collaboration between patients and healthcare providers. Identifying and avoiding triggers, whenever possible, alongside appropriate medical management, can help reduce the frequency and severity of MCAS flare-ups, leading to improved patient outcomes and quality of life.

Sources:

1. Mast Cell Hope. (n.d.). Overview of Mast Cell Diseases. Mast Cell Hope. https://www.mastcellhope.org/education/overview/
2. Theoharides, T. C., Tsilioni, I., & Ren, H. (2019). Recent advances in our understanding of mast cell activation – or should it be mast cell mediator disorders? Expert Review of Clinical Immunology, 15(6), 639–656. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003574/
3. Hamilton, M. J., Hornick, J. L., Akin, C., Castells, M. C., & Greenberger, N. J. (2011). Mast cell activation syndrome: a newly recognized disorder with systemic clinical manifestations. Journal of Allergy and Clinical Immunology, 128(1), 147-152.e2. https://pubmed.ncbi.nlm.nih.gov/21621255/
4. Sarchio, S. N. E., Kok, L. F., O'Sullivan, C., Halliday, G. M., & Byrne, S. N. (2012). Dermal mast cells affect the development of sunlight-induced skin tumours. Experimental Dermatology, 21(4), 241-8. https://pubmed.ncbi.nlm.nih.gov/22276860/
5. Boyden, S. E., Desai, A., Cruse, G., Young, M. L., Bolan, H. C., Scott, L. M., Eisch, A. R., Long, R. D., Lee, C. C., Satorius, C. L., Pakstis, A. J., Olivera, A., Mullikin, J. C., Chouery, E., Mégarbané, A., Medlej-Hashim, M., Kidd, K. K., Kastner, D. L., Metcalfe, D. D., & Komarow, H. D. (2016). Vibratory urticaria associated with a missense variant in ADGRE2. New England Journal of Medicine, 374(7), 656-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782791/
6. Hamilton, M. J. (2018). Nonclonal Mast Cell Activation Syndrome: A Growing Body of Evidence. Immunology and Allergy Clinics of North America, 38(3), 469-481. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049091/
7. Johansson, O., Gangi, S., Liang, Y., Yoshimura, K., Jing, C., & Liu, P. Y. (2001). Cutaneous mast cells are altered in normal healthy volunteers sitting in front of ordinary TVs/PCs--results from open-field provocation experiments. Journal of Cutaneous Pathology, 28(10), 513-9. https://pubmed.ncbi.nlm.nih.gov/11737520/
8. An, S. Y., Hwang, E. K., Kim, J. H., et al. (2011). Vancomycin-associated spontaneous cutaneous adverse drug reactions. Allergy, Asthma & Immunology Research, 3(3), 194-198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121061/

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