Wellapalooza 2016 - 'Mast Cell Activation Disease: Current Concepts' with Lawrence Afrin, M.D.

Dr. Lawrence Afrin overviews current concepts in Mast Cell Activation Disease/Syndrome (MCAD/MCAS), emphasizing that it is a common, often under-recognized disorder marked by inappropriate, episodic mast‑cell mediator release affecting multiple organ systems (skin, GI, cardiovascular, neurologic, respiratory, and GU). He highlights clinical heterogeneity, frequent overlap with conditions such as POTS and hypermobile EDS, and the importance of pattern recognition across systems rather than relying solely on baseline tryptase (often normal). Diagnostic approaches include documenting characteristic multisystem symptoms, excluding alternatives, and demonstrating objective mediator activity (e.g., event‑related rises in tryptase, urinary n‑methylhistamine, prostaglandin D2/11‑β‑PGF2α, leukotriene E4), plus response to mast‑cell–targeted therapy. Management is individualized and stepwise: trigger identification/avoidance; H1 and H2 antihistamines; leukotriene blockers; mast‑cell stabilizers (e.g., cromolyn/ketotifen); cautious use of aspirin for prostaglandin‑driven patients; and, in refractory cases, agents like omalizumab or other targeted therapies. Nonpharmacologic strategies include low‑histamine or elimination diets, stress/sleep optimization, and environmental control. The take‑home message is that careful history, thoughtful testing timed to flares, and personalized, layered therapy can substantially reduce symptom burden even though no single test or treatment fits all patients.