Is it just an allergy? Or is this Mast Cell Activation Syndrome (MCAS)?

Do you sometimes suddenly start itching, your skin turns red and breaks out in rashes? Or do you suddenly feel sick to your stomach and feel like vomiting? Sometimes these things happen after using a certain perfume, or after eating a certain food, and sometimes they can happen for no reason at all. If you can't find a reason for this, and you have different symptoms at different times, it's possible that it's something more than just an allergy. Today we're talking about one such condition, Mast Cell Activation Syndrome (MCAS).

What is Mast Cell Activation Syndrome (MCAS)?

Simply put, MCAS is a condition in which a type of cell in our body called 'mast cells' becomes unnecessarily and overactive, releasing large amounts of the chemicals they contain into the body.

Now let's look at what these mast cells are. Think of these cells as the body's security guards. They are part of our immune system. Their main job is to fight off infections. But allergies are also caused by these cells. Usually, when something harmful to us, for example, an allergen enters the body, these mast cells become activated and release chemicals called 'mediators'. These chemicals are what cause the allergic response in our body. In a healthy person, this process is to protect us.

But, in someone with MCAS, these mast cells are very sensitive . They get overly excited about even the smallest thing and release a huge amount of chemicals at once. It's like bringing an entire army to catch a small thief. These unwanted chemicals are what cause many of the unusual, bothersome symptoms we talked about earlier.

There are several things that can usually trigger these mast cells:

• Infections
• Some medications
• Poison from insect bites
• Fragrances
• Stress
• Exercise
• Some foods
• Sudden changes in temperature

Are MCAS and Mastocytosis two different things?

Yes, don't confuse the two. Although both conditions involve mast cells, they are different.

What causes MCAS?

MCAS can be classified into three main categories based on the cause.

1. Primary MCAS: This is caused by a problem with the mast cells themselves. Often, a mutation in the gene ``(KIT)`` causes these cells to behave abnormally. Mastocytosis is the main condition in this type.

2. Secondary MCAS: This occurs when mast cells are stimulated by another external cause. For example, this can be caused by a severe allergic reaction, a chronic infection, or another medical condition.

3. Idiopathic MCAS: "Idiopathic" means "no cause can be found." The majority of MCAS patients have this type. This means that there is no specific reason why these mast cells are behaving abnormally. Symptoms may appear for new things at any time.

What are the possible symptoms of MCAS?

One of the biggest challenges with MCAS is that the symptoms are so diverse and can affect multiple body systems at once.

Special attention: Anaphylactic Shock

Symptoms of anaphylaxis:

• Difficulty breathing, feeling like your throat is constricted
• Swelling of the lips, tongue, or face
• Heart rate is very fast.
• Sudden drop in blood pressure
• Severe dizziness and fainting
• Vomiting and diarrhea
• Sudden redness and rash all over the body

If you experience one or more of these symptoms, don't delay. Call an ambulance immediately or go to the Emergency Department (ETU) of the nearest hospital.

How do I find out if I have MCAS?

Diagnosing MCAS can be a bit complicated because the symptoms are so varied. Your doctor will usually look for three things in particular.

1. Symptoms: The presence of recurring, chronic allergy-like symptoms in two or more body systems (e.g., skin and intestines).

2. Tests: Blood or urine samples taken when symptoms appear show elevated levels of chemicals such as ``tryptase'' and ``histamine'', which are released by mast cells.

3. Response to treatment: Symptoms decrease when given drugs that block mast cell activity, such as antihistamines.

If all three of these criteria are met, the doctor may suspect MCAS. Sometimes MCAS is accompanied by a condition called ``(POTS)`` - Postural Orthostatic Tachycardia Syndrome. This is when the heart rate increases abnormally upon standing.

How is it treated?

There is no cure for MCAS yet. However, symptoms can be well controlled and a normal life can be achieved. Treatment has two main goals.

1. Avoiding Triggers: The most important thing is to find out what triggers your symptoms and avoid them.

2. Controlling symptoms with medication: The doctor will prescribe you various medications.

• H1 and H2 antihistamines: Drugs like Cetirizine, Loratadine, Famotidine.
• Mast Cell Stabilizers: Drugs that prevent the release of chemicals from mast cells.
• Leukotriene Inhibitors: Drugs like Montelukast.
• For emergencies: If there is a risk of anaphylaxis, doctors advise always keeping an auto-injector (such as EpiPen) containing `(epinephrine)` nearby.

Things to consider when living with MCAS

Living with MCAS can be challenging, but with proper management, you can live successfully with the condition.

• Diet: Certain foods can trigger MCAS. Be especially careful with foods high in histamine (fermented cheese, canned fish, tomatoes, spinach, chocolate). It's best to consult your doctor and see a dietitian to develop a diet plan that's right for you.
• Stress management: Stress is a major trigger for MCAS. Therefore, it is very important to keep your mind relaxed. Things like meditation, yoga, and engaging in a favorite hobby can help.
• Get support: Talk to family and friends about your condition. It can also be helpful to join support groups with people who are going through similar situations.
• Regular communication with your doctor: Talk to your doctor regularly and adjust your treatment plan as needed.

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