Issue link: https://www.massageandbodyworkdigital.com/i/1488451
The triggers for MCAS episodes appear to come and go, or change over time. They can include substances like the chemicals used in fragrances, or certain foods, or they can arise with environmental factors, like exposure to sunlight or a sudden change in temperature—which makes exercising a challenge for many people. The symptomatic profile for MCAS is not uncommon, but the diagnostic process is quite strict. To get an official diagnosis, a person must meet these criteria: • Have severe, recurrent symptoms of mast cell activation that affect at least two organ systems • Show signs of mast cell activation in the form of elevated serum tryptase compared to baseline • Respond to treatment with mast cell stabilizing drugs or drugs that target mast cell mediators According to at least one study, a surprisingly small percentage of people who report MCAS symptoms meet these criteria; 1 another indicator that several related conditions have overlapping symptoms but may need to be treated with differing strategies. HOW IS MCAS TREATED? The first and most important strategy in managing MCAS is to identify the worst triggers and avoid them as much as possible. These can be chemical exposures, including molds, but also the rapid temperature changes that occur with exercise, exposure to sunlight, and histamine-rich or histamine-releasing foods. Aggravating foods include, but are not limited to, fermented, aged, smoked, or dried vegetables or meat; alcohol and fermented drinks; eggplant, tomatoes, and green peppers; avocados, bananas, papayas, citrus fruits, and most berries; shellfish, spinach, beans, and more. The food restrictions for MCAS can be extreme and are usually not meant for long-term use, but once an elimination diet is established, a person can reintroduce various foods to check for reactions. Some medications are triggers and must also be avoided. They include some nonsteroidal anti- inf lammatory drugs, certain high blood pressure medications, and narcotic analgesics. Medications that can help people with MCAS include type 1 and type 2 antihistamines and epinephrine in case of anaphylaxis. IMPLICATIONS FOR MASSAGE THERAPY PRACTICE Trying to sort out mast cell activation syndrome from multiple chemical sensitivity syndrome, histamine intolerance, hypermobility Ehlers-Danlos syndrome, POTS, fibromyalgia, and associated chronic pain syndromes is like trying to untangle knotted up fishing line—many threads lead in promising directions. Does it start with thalamic glial cells? Distorted connective tissue? Diamine oxidase (DAO) deficiency? Or, are they all snarled up with each other? Yank on one, and everything else comes along for the ride. At this point, it isn't possible to delineate between MCAS and related conditions, or to design an organizational chart to lay out how they relate to each other. It would be nice to be able to do that so people who are affected might have better options to manage them, but we aren't there yet. What does this mean for massage therapists? As with all confusing situations, we must fall back on core principles: We identify the variables that will allow us to offer safe, effective work. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 75 PATHOLOGY PERSPECTIVES