Dr. Carlson and the team at Restore Health Today are very experienced in diagnosing and treating patients suffering from Mast Cell Activation Syndrome. While much of the diagnosis can come from a thorough intake and patient workup, as the many symptoms throughout the body can be quite misleading if you don’t know what to look for, confirmation tests can be run. 

Lab Tests Performed to Diagnose MCAS:

One confirmation test is a Tryptase Level, but the test has to be very carefully done, and sometimes is falsely negative (is not accurate), so that it is reasonable to empirically treat with pharmaceutical or nutraceutical meds effective in decreasing the effect of the inflammatory mediators that come from the Mast Cells. The ones we know the most about are histamines and leukotrienes, although there are some 200 different inflammatory mediators that are released from mast cells.

Other common and effective lab tests to help diagnose patient with MCAS are the following: Plasma Histamine, N-methylhistamine 24 hour urine test, Serum Chromogranin A, Leukotrienes, Plasma Heparin, Prostaglandins PGD2 Urine Test.

The patient must be experiencing symptoms of MCAS in order for results from lab tests to be accurate.

Common Treatments For MCAS:

In prescribing treatment, we look for reasons that the mast cells are destabilized to help narrow our focus on the actual triggers of MCAS with each patient. These can include any of the following three things:

Toxin Overload

Nutrient Deficiency

Hidden Infections

If the trigger is an infection, then we at Restore Health Today we treat with a pharmaceutical or nutraceutical antibiotic, antiparasitic, antiviral, antibacterial, or antifungal medication or modality.

If the patient has (and they usually do) inflammation, then at Restore Health Today we use pharmaceutical or nutraceutical anti-inflammatories, optimized Vitamin D, any IVs which can decrease inflammation, Omega 3s, as well as any other modality that helps unload toxins.

If it is found that the patient has symptoms of easy clotting (hypercoaguability) they will need either pharmaceutical or nutraceutical blood thinners.

*** It is important to understand that there is no main approach that works for every single patient. It requires patience and extensive communication and collaboration on both the physician’s and the patient’s part. Oftentimes patients and physicians alike want to hit the symptoms with a multi-med/multi-supplement/multi-modality approach. It is important to add one treatment modality at a time.

Dr. Carlson will typically empirically start with Histamine One Receptor Blockers like Benadyl and Zyrtec if the patient does not have a history of heart rythym problems (more specifically, prolonged QT syndrome). At the same time, he starts the patient on Pepcid twice a day. Pepcid is known to the general public as a medicine to treat ulcers, and which decreases acid production in the stomach. But pepcid, as a Histamine 2 Receptor Blocker, is also helpful for blocking H2 receptors found in other parts of the body.

At the same time, he will start the patient on Quercetin, a nutraceutical which is an H1 and H2 blocker as well as a mast cell membrane stabilizer.

Cromolyn Sodium (what we have used for many years in a metered dose inhaler ((“Intal”)) for exercise-and cold-induced asthma) is also a mast cell membrane stabilizer, and is covered by most insurances, which is a good thing, because in the oral form, it is very expensive.

A fourth category of medication (or supplement) for MCAS is an enzyme which breaks down histamines, which is called diamine oxidase. A common brand of this is “Hist-DAO”. It is also useful to be on a low histamine diet, which you can easily google to learn more about.