74 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3
Partners in
Inflammation
MCAS or MCAS-like
symptoms are seen in
conjunction with a host
of other conditions.
Often the associations
are not hard to follow,
but sometimes the links
are obscure even though
the pattern of MCAS
alongside certain other
conditions is predictable.
• Fibromyalgia and
associated conditions
MCAS symptoms are
often seen with people
who have fibromyalgia,
chronic fatigue
syndrome, irritable
bowel syndrome,
chronic pelvic pain
syndrome, and
migraine. One theory
suggests mast cells
in the central nervous
system are affected,
and this may lead to the
release of inflammatory
cytokines in the skin
that irritate neurons.
This may link MCAS to
both peripheral and
central sensitization.
If this finding is
confirmed, it may
lead to new treatment
options for these
challenging conditions.
• Hypermobility Ehlers-
Danlos syndrome
(h-EDS), and postural
orthostatic tachycardia
syndrome (POTS)
These conditions
frequently overlap,
and it turns out that
a substantial portion
of people living with
h-EDS and POTS also
have symptoms of
MCAS. The link isn't
clear, but one theory
suggests h-EDS
alters the formation
of connective tissue,
and that may change
the behavior of mast
cells that are located
within the connective
tissue framework.
POTS is discussed in
the January/February
2020 issue of Massage
& Bodywork magazine,
and h-EDS is discussed
in the November/
December 2019 issue.
• Multiple chemical
sensitivity syndrome
(MCCS), idiopathic
environmental
intolerance, and
chemical intolerance
These conditions may
have slightly different
presentations of the
same thing, or they
may be distinct from
each other. They are
described as situations
that arise from a history
of exposure to toxic
substances—a single,
large-scale exposure,
or multiple smaller
exposures—and this
leads to multi-system
symptoms in response
to triggers that are not
problematic for other
people, just like MCAS.
MCSS and its associated
syndromes may be the
result of a combination
of immune system,
respiratory system, and
central nervous system
functions. Symptoms
may be worsened
by anxiety (some
researchers suggest
that symptoms may be
caused by anxiety and
dysfunctional coping
skills). Another line
of thought suggests
these are a type of
central sensitization,
with altered processing
of stimuli that leads
to headache, rash,
asthma, muscle and
joint pain, fatigue, and
cognitive problems.
• Histamine intolerance
This is a poorly
understood situation in
which mast cells release
too much histamine,
leading to exaggerated
inflammation.
Histamine intolerance
may be related to
a lack of diamine
oxidase (DAO), an
enzyme that helps
break down histamine.
This condition is
associated with certain
medications, leaky
gut syndrome (a
situation that allows
incompletely broken-
down nutrients to
enter the bloodstream),
inflammatory bowel
disease, and bacterial
overgrowth in the
GI tract (see "Small
Intestine Bacterial
Overgrowth," Massage
& Bodywork, May/
June 2019).
• Others
MCAS or other
histamine-related
imbalances are also
associated with other
long-term inflammatory
conditions, like long
COVID (see "Unpacking
the Long Haul: What
You Need to Know
about Massage Therapy
and Long COVID,"
Massage & Bodywork,
January/February, 2022),
alpha-gal syndrome
(see "Tick-Borne Meat
Allergies," Massage &
Bodywork, November/
December 2018),
lipedema (see "The
Skinny on Painful Fat,"
Massage & Bodywork,
January/February 2021),
gastroesophageal
reflux disorder,
anxiety, depression,
and many others.
