Understanding Mast Cells in Allergies

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Allergies have become a common problem for many people around the world. These allergies can be mild or severe, but some are unpredictable and can be life-threatening.

One of the primary culprits responsible for such unpredictable allergic reactions is the mast cell. In this article, we will discuss what mast cells are and how they contribute to allergies. We will also explore the treatment available for Mast Cell Activation Syndrome (MCAS).

What are Mast Cells?

Mast Cells in Allergies

Mast cells are an essential component of the immune system, which plays a crucial role in allergies. They are found in various tissues throughout the body, including the skin, respiratory tract, and digestive system.

Mast cells have granules filled with chemicals such as histamine, proteases, cytokines, and chemokines. These chemicals are released when mast cells are activated by allergens, infections, or other triggers.

The release of these inflammatory chemicals causes symptoms such as itching, swelling, redness, and pain. Additionally, histamine released by mast cells can cause anaphylaxis, a severe and potentially life-threatening allergic reaction that affects multiple systems in the body.

How do Mast Cells Contribute to Allergies?

Allergic reactions occur when the immune system reacts to harmless substances such as pollen, food, or drugs as if they were dangerous. When an allergen enters the body, it binds to specific antibodies called Immunoglobulin E (IgE), which are attached to mast cells.

The binding of allergen to IgE triggers the activation of mast cells, leading to the release of inflammatory chemicals mentioned above.

The symptoms of an allergic reaction depend on the location of mast cells and the type of allergen involved. For example, in seasonal allergies, mast cells in the nasal passages release histamine, causing sneezing, runny nose, and congestion.

In food allergies, mast cells in the digestive system release histamine, causing abdominal pain, diarrhea, and vomiting.

What is Mast Cell Activation Syndrome?

Mast Cell Activation Syndrome

Mast Cell Activation Syndrome (MCAS) is a type of immune disorder that occurs when mast cells are activated excessively or inappropriately, leading to symptoms similar to an allergic reaction.

MCAS can be triggered by various factors, including infections, stress, medications, or environmental exposures. The symptoms of MCAS can be mild or severe and can affect multiple systems in the body, making it challenging to diagnose.

The most common symptoms of MCAS include flushing, itching, hives, abdominal pain, diarrhea, and shortness of breath.

These symptoms can occur spontaneously or after exposure to triggers such as heat, exercise, or certain foods. In some cases, MCAS can lead to anaphylaxis, a life-threatening allergic reaction.

MCAS was only discovered relatively recently; the name was first used in 2007 and proposed criteria for the condition were published in 2013 — although there still isn’t a proper consensus within the medical community about who should be labeled as having it, explains Dr Emma Reinhold, a former GP, researcher and clinical advisor on MCAS. 

As a result, data on MCAS remains very limited. What little research we do have suggests it disproportionately affects women and people assigned female at birth (AFAB), who outnumber men with MCAS three to one. Perhaps unsurprisingly though, medical science can’t yet explain the disparity. 

“Nearly all of my patients are women, but I’m not sure there’s really much understanding about why that is,” says consultant haematologist Dr Bethan Myers, who works at the University of Leicester NHS Trust. “There is some hormonal link, with mast cells having oestrogen and progesterone receptors, but I don’t think it’s been looked into in much detail.” 

Treatment for Mast Cell Activation Syndrome

Treatment for Mast Cell Activation Syndrome

The treatment for MCAS aims to reduce the activation of mast cells and relieve symptoms. The first step in treating MCAS is to identify and avoid triggers that can activate mast cells. A detailed medical history, physical examination, and laboratory tests can help identify potential triggers and rule out other conditions that can cause similar symptoms.

Once triggers have been identified, medications can be used to prevent or reduce mast cell activation. These medications include antihistamines, leukotriene inhibitors, and mast cell stabilizers. Steroids may also be used to control inflammation in severe cases.

In addition to medication, lifestyle modifications can be helpful in managing MCAS. These modifications include reducing stress, improving sleep quality, and avoiding trigger foods and environmental factors. Some patients may benefit from dietary supplements such as vitamin C, quercetin, and omega-3 fatty acids, which have anti-inflammatory properties.

Amy — who now works in a non-clinical role for the NHS — has tried various options, and currently has injections every four weeks, which help to block mast cell activation. Really though, she says, MCAS is just something she’s had to learn to live with.

“I have a busy job, I have a three-year-old, so it’s really inconvenient for me when a flare does happen; I don’t have time to be unwell. But when you’re having a flare, at least people can obviously see you’re ill if you’re swelling up or covered in hives,” she says.

“I think what people don’t realize, underlying that, is how your body’s constantly attacking itself all the time and you’re exhausted. No one can see that part, and you just have to crack on. I like to think my superpower is that my body regularly tries to kill me, and I don’t die.”

Conclusion

Mast cells are essential components of the immune system that play a crucial role in allergies. When mast cells are activated by allergens or other triggers, they release inflammatory chemicals that cause symptoms of an allergic reaction.

Mast Cell Activation Syndrome is a type of immune disorder that occurs when mast cells are activated excessively or inappropriately, leading to unpredictable and severe symptoms.

Treatment for MCAS aims to reduce the activation of mast cells and relieve symptoms. The first step in treating MCAS is to identify and avoid triggers that can activate mast cells.

Medications such as antihistamines, leukotriene inhibitors, and mast cell stabilizers can be used to prevent or reduce mast cell activation. Lifestyle modifications, such as reducing stress and avoiding trigger foods and environmental factors, can also be helpful.

Although MCAS can be challenging to diagnose and treat, with proper management, most patients can achieve significant improvements in their symptoms and quality of life.

If you suspect you may have MCAS, it’s essential to seek medical attention from a qualified healthcare provider who specializes in allergies and immune disorders.

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