Understanding Mast Cell Activation in EDS & HDS - Dr. Anne Maitland | German (DE)

Dr. Anne Maitland explains how dysregulated mast cells can drive multisystem symptoms commonly seen in people with EDS/HSD and related dysautonomias. She reviews mast cell biology and how inappropriate activation can affect skin, GI tract, cardiovascular and nervous systems—manifesting as rashes/flushing, pruritus, hives/dermatographism, GI pain/diarrhea/reflux, headaches/brain fog, orthostatic intolerance/POTS, wheeze, and connective‑tissue complaints (pain, fragility, poor wound healing). She outlines a pragmatic diagnostic approach: careful history of multisystem, trigger‑linked symptoms; ruling out mimics; and targeted mediator testing (e.g., serum tryptase during flares, urinary histamine metabolites, prostaglandin D2/11‑β‑PGF2α, LTE4), recognizing that results can be variable and that clinical response to therapy supports the diagnosis. Management is tiered: identify/avoid triggers (heat, infections, alcohol, high‑histamine foods, medications like opioids/NSAIDs/contrast), optimize barriers and sleep, and treat with H1 and H2 antihistamines, leukotriene antagonists, cromolyn/ketotifen (mast‑cell stabilizers), and in select cases aspirin for PGD2‑driven flushing, with epinephrine for anaphylaxis. She discusses low‑histamine or individualized elimination diets, cautious reintroduction, and coordination of care for procedures (premedication for contrast/anesthesia). For patients with EDS/HSD and POTS‑like symptoms, she emphasizes that addressing mast‑cell activation can reduce orthostatic intolerance and GI dysmotility, and that strict adherence and careful titration are key given hypersensitivity and variability among patients.