Understanding Mast Cell Activation Syndrome (MCAS): Diagnosis and Treatment by Dr. David Saperstein
Diagnosis of MCAS
Elevated Mediator Levels: Diagnosis hinges on finding elevated levels of mediators (chemicals released by mast cells) in the blood or urine. Key mediators include tryptase and histamine in the blood, and metabolites of histamine (N-methylhistidine) and prostaglandins in urine.
Testing Challenges: Accurate testing requires specific handling and processing of specimens. Labs must keep samples cold and follow precise procedures. Common medications, particularly non-steroidal anti-inflammatories, can impact test results, though antihistamines typically do not.
Alternative Diagnostic Approaches: When blood and urine tests are inconclusive, gastrointestinal biopsies from endoscopy can reveal an excess of mast cells. Sometimes, MCAS is diagnosed based on clinical symptoms and history when test results are not definitive.
Treatment and Management of MCAS
Medications:
Antihistamines: Often used to manage symptoms by blocking histamine, a mediator commonly associated with MCAS.
Mast Cell Stabilizers: Medications like cromolyn sodium help stabilize mast cells and prevent them from releasing mediators.
Leukotriene Inhibitors: These drugs, such as montelukast, can help reduce inflammation and allergic reactions.
Aspirin: In some cases, low doses of aspirin are used, particularly if there's an involvement of prostaglandins.
Diet and Lifestyle Changes: Adjustments to diet and lifestyle can help manage symptoms. This includes avoiding triggers known to provoke mast cell activation.
Individualized Treatment Plans: Treatment is often tailored to the individual's specific symptoms and trigger factors. Regular monitoring and adjustments to the treatment regimen are common.
Additional Information and Resources
Further Learning: Dr. Saperstein mentions additional videos that delve into the management of MCAS and other related topics.
Online Resources: Viewers are encouraged to visit their website for more comprehensive information, including links to educational videos and contact details for further inquiries or assistance.