DR. SANDEEP GUPTAM A S T C E L L A C T I V A T I O N

WHAT ARE MAST CELLS?Found in all tissues of body, especially(around) blood vessels & nerves

Skin, Lungs

Digestive tract

Mouth, Nose

Blood brain barrier

Triggered byIgE & IgG antibodies

Antigens (allergens, bacteria, viruses, fungi, toxins)

Cytokines (inflammation)

Drugs, Physical activity, Hormones

C3a, C5a

When triggered releaseHistamines

Prostaglandins

Heparin

Tryptase

Cytokines (IL-6 et al, MMP-9, TGF-b1)

Other (VEGF, PAI-1)

WHAT IS MAST CELL ACTIVATION SYNDROME?

Mast Cell Disorders

Primary

Mastocytosis

Monoclonal mast cell activation syndrome

Secondary

Allergic disorders

Chronic inflammation or cancer

physical / autoimmune urticarias

Idiopathic

MCAS

Anaphylaxis

Angiodema

Urticarias

First described in early ‘90s but

Not named until 2007

SYMPTOMS OF MCAS

Skin

Flushing, itching, heat, hives, pain

Cardiovascular

Hypotension or hypertension, POTS,

tachycardia

Head

Headaches, migraines, brain fog, anxiety,

depression, vertigo, irritability

GI

Nausea, stomach aches, bloating, cramping,

constipation, loose stools, leaky gut, dysbiosis,

crohn’s disease

Menstrual

Pelvic pain, PMS, endometriosis

Respiratory

Nasal congestion, runny nose, sneezing,

itchy/watery eyes, mucous, wheezing

Systemic

Fatigue, food, drug, chemical sensitivities

NEUROLOGICAL EFFECTS OF MAST CELLS

“MCs play a critical role in neuroinflammation, which is facilitated by their close proximity to nerve fibres in the periphery and meninges of the spinal cord and the

brain”.

“Multifaceted activation of MCs releasing neuropeptides, cytokines and other mediators has direct effects on the neural system as well as neurovascular

interactions. Emerging studies have identified the release of extracellular traps, a phenomenon traditionally meant to ensnare invading pathogens, as a cause of MC-

induced neural injury”.

Extracellular traps involve citrullination of histone proteins and are dependent on ROS formation and engagement of toll-like receptor 4 (TLR4)

Reference: Mittal, A. et al. (2019). Mast Cell Neural Interactions in Health and Disease. Front Cell Neuro.

NEUROLOGICAL SYMPTOMS OF MCAS

Headaches Brain fog

Insomnia

Difficulties with tinnitus, balance and

co-ordination

A N E C D O T A L L Y M C A S H A S B E E N A S S O C I A T E D W I T H A L M O S T

E V E R Y C A S E 0 F S E V E R E S E N S I T I V I T Y I H A V E S E E N

BIOMARKER TESTING

Tryptase(serum)

Chromogranin A (serum)

Eosinophilic Cationic Protein (ECP)

Histamine(chilled plasma or whole blood)

Matrix Metalloproteinase-9

N-methylhistamine(24 hr urine)

Increase over baseline of 20% (+ 2 ng/mL)

OR baseline > 15 (NR < 11.5 ng/mL)

No definitive test(s)

MCAS is a clinical diagnosis

Can aid diagnosis and help to

track treatment

Can be elevated but rule out heart failure, renal

problems, tumors and PPI use

WB NR 28-51 ug/L

NR < 200 mcg/g

Abnormal is above 350mg/dl

PGF2a NR < 1000 ng/24h

MCAS AND OTHER CONDITIONS

CIRSMCAS 30-50%

MCAS also involved in

Allergies & Asthma

Autism

Autoimmune disorders

(hasthimoto’s, lupus, MS, RA,

eczema)

Celiac disease

ME/CFS, Fibromyalgia

Food allergy and intolerances

GERD

Infertility

Interstitial cystitis

IBS

Migraines

Mood disorders

MCS

POTS

& more

TREATMENT – REMOVE TRIGGERS

mold illnessS IM P L EMADE

MCAS

Metals, plastics,

pesticides

Allergens, foods,

physical triggers

CIRS/mold, stealth

infections

Block the mediator

Stablisemast cells

Remove triggers

TREATMENT OF MCAS – FINDING & TREATING CAUSATIVE FACTORS

Mould exposure

(internal or external)

Oxalosis

Glyphosate & heavy metal

toxicity

Mould exposure

(internal or external)

Oxalosis

Bartonella and other bacterial infections

Parasitic infections

Glyphosate and heavy

metal toxicity

Anti-histamines

H1 blockers

Doxepine

Diphenydramine(Benadryl, Unisom)

Cetririzine(Zyrtec)

Loratadine(Clarityne)

H2 blockers

Famotidine (Pepcid)Cimetidine (Tagamet)

Ranitidine(Zantac)

TREATMENT OF MCAS –PHARMACEUTICALS

Can be administered IV as a

rescue therapy

TREATMENT OF MCAS – PHARMACEUTICALS (CONT.)

mold illnessS IM P L EMADE

Mast cell stabilizers

Cromolyn Ketotifen Hyroxyurea

Leukotriene inhibitors

Montelukast(Singulair)

Zafilukast(Accolate)

Tyrosine kinase inhibitors

Imatinib

Often agents of choice

TREATMENT – SUPPLEMENTS

Natural anti-histamines & mast cell stabilizers

DAO Enzymes

Probiotics

Medicinal cannabis

•Quercetin, luteolin rutin, blackseed oil

•B6 / P5P

•Omega 3s, curcumin Alpha lipoic acid

•NAC / SAMe, B12, methylfolate

•Umbrellux DAO(15-20 min before meals)

•Lactobacillus rhamnosus

•Bifidobacter sppSpore-based probiotics

•TCH & CBD combined products (eg 60% CBD, 40% THC)

TREATMENT – LOW HISTAMINE DIET

mold illnessS IM P L EMADE

• Raw and cured meats

• Processed and smoked fish

CuredMeat

• Alcohol

• Chocolate

• NutsTreats

• Soy sauce and fermented soy

• Aged cheese

• Pickles

Fermented foods

• Spinach (large quantities) / Citrus fruits

• Tomatoes, ketchup/tomato sauces

• Artificial food colorings & preservatives

• Yeast, yeast extracts

Other

Avoid/reduce

TREATMENT - PRIORITIZATION

Removal from Mold

MCAS(Mast Cell Activation Syndrome)

Nutrient Support (KPU etc)

VirusesParasitesBabesia/Bartonella

Ehrlichia/Anaplasma

Borrelia Other

Stealth infectionsMARCoNS

Questions and Answers

mold illnessS IM P L EMADE