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Mast Cell Activation Syndrome and Postural Orthostatic Tachycardia Syndrome

food-salad-healthy-lunchMast Cell Activation Syndrome (MCAS), also known as Mast Cell Activation Disorder is an immunological condition in which mast cells inappropriately and excessively release chemical mediators which then results in a number of symptoms.


There is significant overlap between MCAS and Postural Orthostatic Tachycardia Syndrome (POTS) and other forms of dysautonomia.  It is not clear which syndrome comes first and the intersection between the conditions is complicated.


Mast cells are present throughout the body. They are the central cells in immediate allergic reactions that secrete up to 200 different chemicals, namely histamine, in response to different stimuli.  Mast cells are normally frequently releasing, however, in this disorder they are considered hyper responsive.


Common symptoms include:

-Recurrent abdominal pain



-Nasal congestion





Although different diagnostic criteria are published, commonly used strategies to diagnose patients include the presence of the following:


*A combination of the symptoms listed above

*Laboratory evidence of mast cell mediator

*Improvement in symptoms with the use of medications that block or treat elevations in these mediators


Common triggers that can aggravate symptoms include:


-Specific food and drinks (especially alcohol and foods naturally high in histamine)

-Temperature extremes

-Airborne smells, perfumes, and smoke

-Exercise or exertion

-Emotional stress

-Hormonal changes




Treatment is complex and must be individualized.  It often involves a combination of: medication, lifestyle adjustments, health and behavioral interventions, and diet modification.  Identifying common triggers such as: smell, touch, or specific foods is an important step.


A low histamine diet and/or an elimination diet could also be helpful in identifying specific foods that may trigger a response.  The POTS Treatment Center’s Registered Dietitian Nutritionist can assist with this type of approach.


Carey Shore, Msc, RD, LD Registered Dietitian Nutritionist