Mast Cell Activation Syndrome (MCAS) is a condition in which the patient experiences repeated episodes of the symptoms of anaphylaxis – allergic symptoms such as hives, swelling, low blood pressure, difficulty breathing and severe diarrhea. High levels of mast cell mediators are released during those episodes. The episodes respond to treatment with inhibitors or blockers of mast cell mediators. The episodes are called “idiopathic” which means that the mechanism is unknown – that is, not caused by allergic antibody or secondary to other known conditions that activate normal mast cells. Learn more about MCAS at the Mast Cell Disease Society.
The itchiness which accompanies using vibration plates is usually lymph fluid being fluidized from fast twitch muscle contraction. To remedy this, try off-plate muscle contraction (lower then upper body) to move lymph to exit the body, such as chair squats or leg lifts or swings, then wall or counter pushups or planks.
Antihistamines are a class of agents that block histamine release from histamine-1 receptors and are mostly used to treat allergies or cold and flu symptoms. Histamine-1 receptors are located in the airways, blood vessels and gastrointestinal tract (stomach and esophagus). Stimulation of these receptors can lead to conditions such as a skin rash or inflammation, a narrowing of the airways (bronchoconstriction), hay fever, or motion sickness. Histamine-1 receptors are also found in the brain and spinal cord, and stimulation of these receptors makes you more awake and alert. Sedating antihistamines oppose the effects of histamine on H1 receptors in your brain, which is why they cause sedation and drowsiness.
Histamine-1 receptors are located in the airways, blood vessels and gastrointestinal tract (stomach and esophagus). Stimulation of these receptors can lead to conditions such as a skin rash or inflammation, a narrowing of the airways (bronchoconstriction), hay fever, or motion sickness. Histamine-1 receptors are also found in the brain and spinal cord, and stimulation of these receptors makes you more awake and alert. Sedating antihistamines oppose the effects of histamine on H1 receptors in your brain, which is why they cause sedation and drowsiness.
Antihistamines can be classified into two main categories: first-generation and second-generation. First-generation antihistamines were developed more than seventy years ago. They act on histamine receptors in the brain and spinal cord and in the rest of the body (called the periphery). They also act on muscarinic, alpha-adrenergic, and serotonin receptors. This means that first-generation antihistamines are more likely to cause side effects such as sedation, dry mouth, dizziness, low blood pressure, and a rapid heart-beat. They are also more likely than second-generation antihistamines to impair a person’s ability to drive or operate machinery. Second-generation antihistamines were developed in the 1980s and are much less sedating. They act on histamine-1 receptors in the periphery and are unlikely to penetrate the brain. Most second-generation antihistamines do not cause drowsiness.
First-generation antihistamines include: brompheniramine (Bromax, Lodrane), carbinoxamine maleate (Karbinal ER), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), and triprolidine (Tripohist). Second-generation antihistamines include: azelastine nasal spray (Astelin), cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), levocetirizine (Xyzal), loratadine (Alavert, Claritin), and olopatadine nasal spray (Patanase).
Another way to control histamine is through H2 blockers in the gut. Histamine stimulates cells in the stomach lining to make hydrochloric acid. H2 blockers bind to histamine receptors in the stomach, reducing the amount of acid that the lining secretes, and therefore lessening allergic symptoms. There are several on the market: cimetidine (Tagamet), nizatidine (Axid, Tazac), and famotidine (Pepcid).
Once formed, histamine is broken down by an enzyme called diamine oxidase (DAO) in the digestive tract. Digestive issues such as leaky gut and gluten intolerance or any other inflammatory process in the gut simply adds to the inability to breakdown dietary histamine since deficiencies in DAO and/or methyl groups also increases symptoms of histamine intolerance.
In April 2020, the Food and Drug Administration requested that all forms of ranitidine (Zantac) be removed from the US market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen, were present in some ranitidine products.
Conners, K. (n.d.). High histamine food list for your histamine-free diet. Conners Clinic. https://www.connersclinic.com/high-histamine-foods-list
Fookes, C. (2019, February 5). Antihistamines. Drugs.com. https://www.drugs.com/drug-class/antihistamines.html
Mast cell activation syndrome. (n.d.). American Academy of Allergy, Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/related-conditions/mcas
Villines, Z. (2020, January 27). What to know about H2 blockers. Medical News Today. https://www.medicalnewstoday.com/articles/h2-blockers#types
Dempsey, T. (2022, April 28). Vitamin D: A fresh perspective. Dr. Tanian Dempsey. https://www.drtaniadempsey.com/post/vitamin-d-a-fresh-perspective
SAMe supplements mast cell stabilizer
Sources of Histamine
Avoid from these high histamine foods: alcohol (fermented beverages, especially wine, champagne and beer), avocados, chickpeas, most citrus fruits, cured meats (bacon, hot dogs, luncheon meats, pepperoni, salami), dried fruit (apricots, dates, figs, prunes, raisins), eggplant, fermented foods and drinks (kefir, kombucha, sauerkraut, soy sauce, vinegar, yogurt), matured cheeses (asiago, banon, bleu, brandaske, camembert, castelo branco, cheddar, emmentaler, gouda, goat cheese, gorgonzola, gruyere, parmigiano), mushrooms, nuts (cashews, peanuts, walnuts), pickled or canned foods, processed meats, ready meals, salty snacks, shellfish, smoked meat products (anchovies, ham, mackerel, mahi-mahi, sardines, salami, sausages, tuna), soured foods (buttermilk, soured bread, sour cream, sour milk), soy beans, spinach, sweets (with preservatives and artificial colorings), tofu, tomatoes, vinegar-containing foods (mayonnaise, olives, pickles), and yeast products. Overripe fruits and refrigerated leftovers also contain high levels of histamine due to the face that bacteria produce excess histamine.
Histamine liberators are foods that themselves are low in histamines. However, they help release histamines in other foods and are good to limit in your diet: additives (benzoate, food dyes, glutamate, nitrites, sulfites), beans, chocolates and cocoa, citrus fruits (kiwi, lemon, lime, pineapple, plums), nuts, papaya, tomatoes, and wheat germ.
Diamine oxidase (DAO) blockers are foods that have the ability to prevent diamine oxidase enzymes from breaking down histamine in your body. Consider removing these from your diet as well: alcohol, black tea, energy drinks, green tea, and mate tea. It should be noted that N-acetylcysteine is also a DAO inhibitor.
Supplements
Quercetin is a mast cell stabilizer. Cilantro, basil, thyme, ginger, onion, mangosteen, and nigella sativa are natural H1 blockers. Holy basil and ginger are natural H2 blockers.
For people with MCAS, the stabilizing influence of vitamin D is essential. While it is difficult in many cases to determine the exact cause of MCAS, vitamin D deficiency may play a role. Without the soothing signals from vitamin D to calm mediator production, mast cells are vulnerable to inappropriate activation and chronic release of inflammatory and allergic mediators.
DAO Deficiency and Histamine | MTHFR Support
Histamine Intolerance: Methylation, the Gut, and Copper | Eat For Life
Medications That Cause Histamine Intolerance Symptoms | Dr. Hagmeyer
Supplements for Histamine Intolerance | Nutrition By Erin
What Are Chelated Minerals, and Do They Have Benefits? | Healthline
What are the Dangers of Chelated Copper Supplements? | LiveStrong
Zinc Depletion and Histamine Intolerance | Healing Histamine
Symptoms Tracker
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Epinephrine Savings Offers
Epinephrine is vital for those with severe allergies and mast cell activation syndrome.
Research
Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options | G. Molderings, S. Brettner, J. Homann and L. Afrin (2011)
Pharmacological treatment options for mast cell activation disease | G. Molderings, B. Haenisch, S. Brettner, J. Homann, M. Menzen, F. Dumoulin … and L. Afrin (2016)
Probiotic Lactobacillus rhamnosus downregulates FCER1 and HRH4 expression in human mast cells | A. Oksaharju, M. Kankainen, R. Kekkonen, K. Lindstedt, P. Kovanen, R. Korpela and M. Miettinen (2011)
More About Mast Cell Activation Syndrome
3 Easy Steps to Clean Histamine from Your Body | Conners Clinic
12 Tips for Living With Mast Cell Activation Syndrome | Dr. Bruce Hoffman
The Best MCAS Supplements & Diet: 3 Steps to Calm a Flare | Dr. Lauryn Lax
Healing Histamine Blog | Healing Histamine
Histamine Hack: Here’s How to Safely Eat Fermented Foods | Body Ecology
Mast Cell Activation Syndrome | Genetic and Rare Diseases Information Center
Mast Cell Activation Syndrome Can Present as Depression, Anxiety, or Brain Fog | Psychology Today
Mast Cell Activation Syndrome Questions Answered | Dr. Tania Dempsey
Mast Cell Activation Syndrome: Symptoms and Solutions | Dr. David Jockers
Nambudripad Allergy Elimination Techniques | NAET
Natural Treatments for Mast Cell Activation Syndrome | Hoffman Centre
Salicylate Sensitivity Food Guide PDF | By The Bay Kinesiology
What is the Best Antihistamine for Itching? | Walrus
What is Histamine? | Healing Histamine
What is Histamine Intolerance and How Can You Address It? | Mast Cell 360
What to Eat (and NOT eat!) with Mast Cell Activation Syndrome – Going Beyond Low Histamine Lists | Mast Cell 360
When to Suspect MCAD | Oh Twist
