“I’ve been treated for SIBO multiple times, but still have symptoms.”
“I’m sensitive to everything – smells, supplements, foods, you name it!”
“I get rashes/hives without any known trigger – dermatologists can’t figure out how to help me.”
“I’m sensitive to a lot of foods, and can only eat a few foods.”
“I’ve done a lot of gut testing and treatments, but nothing seems to make my symptoms completely go away.”
I hear at least one of these concerns from patients in whom I suspect Mast Cell Activation Syndrome (MCAS), which I prefer to call Mast Cell Hyperactivity (which implies that we then work to “calm” the mast cells).
Mast cells, which are located all over the body in tissues (but not in the bloodstream), are part of the immune system. They are intended to protect us! Mast cells release over 200 chemicals like histamine and heparin when responding to a potential threat in the body. In the right quantity, these chemicals are anti-inflammatory and increase blood flow (to eliminate infections, allergens, or inflammation). Histamine, in fact, is actually involved in motivation and wakefulness so we need some for optimal brain function!
When mast cells become chronically over-active, the molecules they release can lead to a variety of symptoms.
This condition/biological state is not widely recognized by mainstream medicine, since it is a relatively new known phenomenon, so it is a frustrating condition to identify and treat.
There are a lot of symptoms associated with MCAS. A lot! Anyone can develop “medical student syndrome” just by reading through these lists (especially the list found on this site)! And many of the symptoms in MCAS can be attributed to other conditions! Some people have primarily gut symptoms, others experience respiratory symptoms; some have more skin issues, and others have significant cognitive issues.
Testing for MCAS is not very accurate at this time, primarily due to the short-lived nature of the molecules that we can test for, so we have to rely on a collection of symptoms and the response to treatments to make a diagnosis.
Instead of reading through the list of symptoms, however, I recommend starting with the questionnaire below. It is based off the questionnaire found in Dr. Lawrence Afrin’s 2014 article, “A concise, practical guide to diagnostic assessment for mast cell activation disease.” I just simplified the language in the list, and categorized the questions differently (to make it easier to fill out)!
WHAT CONDITIONS MAY INCLUDE MAST CELL HYPERACTIVITY?
The role of mast cells in chronic disease states is still poorly understood, and some research is finding associations of various conditions with mast cell hyperactivity. Conditions that may have a mast cell hyperactivity component include:
- Fibromyalgia (related to mast cells in the thalamus) (see this article)
- Small fiber neuropathy (81% may have MCAS per this article)
- Chronic pain (including CRPS, chronic regional pain syndrome) (see this article)
- OCD (Obsessive Compulsive Disorder)
- Unexplained Urticaria (hives)
- Anxiety (one of the most common symptoms we see in MCAS patients)
- Difficulties concentrating (including ADHD, bipolar conditions)
To complicate matters further, many conditions/symptoms tend to co-occur with MCAS, which includes the following:
- Hypermobility/EDS (Ehlers Danlos Syndrome) body types
- Dysautonomia (e.g. POTS or postural orthostatic tachycardia syndrome) or small fiber neuropathy
- Gastroparesis (some clinicians use low elastase on stool testing, <200, as a marker as well of mast cell involvement in the GI system)
- Sensitivity to smells, sounds, EMFs, light, pharmaceutical and even supplement treatments.
- Adverse childhood experiences (ACEs), medical trauma, gaslighting.
- Significant stress (which “turns on” the area of our nervous system known as the limbic system – an area that plays a significant role in turning on mast cells, and inhibits the vagus nerve which is intended to calm the body and thus calm mast cells).
Dr. Andrew Maxwell (a pediatric cardiologist) groups 4 of the above in addition to MCAS into what he calls the Pentad Super Syndrome (POTS/dysautonomia, MCAS, GI dysfunction, autoimmunity, and hyper mobility type EDS).
WHAT CAUSES MAST CELL HYPERACTIVITY?
Right now, there is no known cause. In functional medicine, we currently suspect that the following are the primary triggers:
- Chronic sympathetic nervous system activation
- Pathogens (e.g. Lyme disease, reactivated viral illness) or dysbiosis (often related to our lifestyle)
- Environmental toxins (especially mycotoxins from indoor mold)
- Sluggish detox pathways
Let me expand on these a little further…
Mast cells are inherently part of our immune system, and are responding to neurological triggers. A key question to ask in one with suspected MCAS is “what is the body trying to protect itself from?”
- Persistent stress (the hormone cortisol causes mast cells to release their inflammatory molecules)
- Unresolved trauma
- Not feeling safe in our bodies, or in control of our life
- Excessive stimulation without allowing prolonged relaxation (e.g. always on-the-go, lots of stress, excessive exercise)
- Structural issues
- Ehlers Danlos Syndrome
- Cervical issues (I highly recommend evaluation for CCI aka Craniocervical Instability and C1/C2 imbalances per a chiropractor that practices the Blaire Technique or NUCCA)
- Head trauma including from mild repetitive sports trauma (gymnastics, martial arts)
- Tick-borne illness
- Gastrointestinal dysbiosis
- Parasites (but also can occur in the liver, gall bladder, lungs, bladder, rarely the brain – location best identified via Autonomic Response Testing) – best addressed with herbals, often cyclical treatments for 6 months (e.g. with Wormwood, Myrrh, mimosa pudica, prescription anti-parasites)
- Biofilm build up
- SIBO (Small Intestinal Bacterial Overgrowth – aka small bowel dysbiosis) and/or SIFO (Small Intestinal Fungal Overgrowth)
- Virus reactivation
- “Unusual” triggers (e.g. immune reactivity to Chlamydia pneumonia, Mycoplasma pneumonia)
- “External parasites” (e.g. toxic relationships, jobs)
- Indoor mold toxins (aka mycotoxins)
- Multiple chemical sensitivity
- Chemical exposure in home/work
- Pesticides (especially glyphosate)
- Genetic predispositions
- Impaired bile flow
- Liver stress (e.g. from pharmaceuticals, alcohol use)
- Gastrointestinal imbalances
HOW DO YOU DIAGNOSE MCAS?
There are some imperfect ways to test for MCAS, which involve blood tests, urine tests, or tissue biopsies. Since this is often an “expensive” condition, I highly recommend using treatments as “tests” rather than trying to get a diagnosis from any of the following tests (since each can be hundreds if not over a thousand dollars when/if insurance doesn’t cover it). But for completeness, the current tests include (the starred options are the ones that appear to be most reliable at this time per Dr. Theoharides or Dr. Afrin):
- Urine 24 hour tests or (**) first morning urine testing (but must be kept cold for accuracy, otherwise these molecules won’t show up):
- ** Methylhistamine or MIA
- ** Prostaglandin D2 (PGD2)
- ** VEGF
- ** IL-6 (don’t test if known pre-existing inflammatory condition)
- ** Total IgE
- ** Total IgG4
- Immune IgE allergy panel
- RAST for alpha-gal, casein, gluten, dust mites, fungi, grass, pollen
- Anti-IgE receptor antibody (basophil activation)
- Food intolerance panel (IgG4)
- Ideally only eat chicken and rice for 2-3 days prior to this, per Dr. Theoharides
- Prostaglandin D2 (PGD2)
- IL-4, IL-31, IL-33
- Chemokine Ligand 2 (CCL2)
- CXCL8 (IL-8)
- GI biopsies (latest biomarkers include CD117 stained mast cells, tryptase depletion index)
However, these are abnormal in only a small percentage of people who I suspect to have MCAS (and who subsequently respond to treatments), so I rarely run these tests anymore. Dr. Theoharides points out, too, that there are more important molecules involved that we currently don’t measure routinely, including IL-31 and Platelet Activating Factor (PAF). And for those with suspected chronic spontaneous urticaria, and basophil activation test (BAT) may be warranted.
Other tests to consider:
- NeuroQuant (an imaging test), which can be particularly good at showing hyperactivity of certain ares of the brain (e.g. limbic system and the need to calm it down!)
- Homocysteine (if high, associated with high histamine, under-methylation, or even lead toxicity)
- Genetic testing of SNPs (single nucleotide polymorphisms) to determine if someone is a fast or slow metabolizer, which can aid treatment dosing
Most diagnoses at this time, however, are based off medical history and the collection of symptoms that suggest MCAS. And I would add the response to treatments can be a “test” as well (although a treatment must be given 6-8 weeks to work before considering it ineffective). I’ve listed a lot of treatment potentials below.
The questionnaire at the end of this article is one of the more validated ways to diagnose suspected MCAS. It is based off symptoms, medical history, and test results. It will take 5-10 minutes to complete, and there is no need to share email information – completing it will just give you a score.
We must remember that MCAS is still a poorly understood condition, and information is constantly evolving. Right now, we don’t have good tests to definitively diagnose MCAS.
Why is it so difficult to receive a diagnosis from tests?
- First, most of the testing occurs when someone either doesn’t have symptoms, or in the middle of an episode of symptoms.
- Second, the chemicals released by mast cells are only circulating in the body (i.e. testable) for a short time – often only a few minutes – and require particular temperatures to stay stable during transportation to the testing facility.
- Third, most tests available are only able to be run through a few laboratories (so many samples are shipped to these locations).
However, the symptoms of MCAS are often attributable to other illnesses, so I don’t recommend considering MCAS as a diagnosis based solely off a list of symptoms. I’ve unfortunately seen patients (and my colleagues in functional medicine) falsely self-diagnose just off a list of symptoms.
The following questionnaire can help, but response to treatments are something to add to the “diagnosis”. Luckily, most treatments can be purchased over the counter (but the timing and dosing of these matters, which is why I recommend appropriate guidance from a medical or nutrition professional).
HOW DO YOU TREAT MCAS?
The main focus needs to be finding the right combination of treatments to calm down symptoms before taking a deep dive into triggers so the body can handle treatments better. This can involve trial/error, so be patient! As you see below, functional and integrative medicine has MANY options for treatment, so please work with a knowledgeable practitioner on use of these. In my experience, many with mast cell hyperactivity are very sensitive to treatments and may need to start with 1/4 of a dose, single ingredients, or even use a pinch of a treatment in 8oz of water and build up slowly. One new treatment option every 2-3 weeks is also recommended, since it can take 6 weeks or more to see improvement (and more treatments are not better in MCAS).
The list of treatments below is long, which I categorize according to their most powerful functions. I generally try to have 3-5 treatments for the symptoms of my mast cell hypersensitivity patients, adding one at a time. My comprehensive approach, though, depends on the most dominant symptoms (e.g. hives versus gut versus neurological), and include the following:
- Always address the basics first (building blocks to a healthy body): replete nutrient and mineral deficiencies, drink clean filtered water with added electrolytes (Clearly Filtered, Berkey, or Reverse Osmosis filters best), have a bowel movement daily, and start addressing the environment where someone lives.
- “Non-pill” neurological support (e.g. limbic system retraining, vagus nerve support, neuroinhibition)
- Work on avoiding triggers of mast cells, especially uncontrolled stress.
- Mast cell stabilizers
- Inhibitory treatments per symptoms
- Additional support if indicated from labs, symptoms
See the list of possible treatments below. Note that these are provided for educational purposes, and are not intended to be used for personal treatment without the guidance of a practitioner. Many with MCAS are sensitive to treatments, which often can be due to added binders in the medications (so compounded prescriptions may be better).
Rebalance the nervous system (key role in “turning on” mast cells): Especially the limbic system (which “turns on” mast cells) and vagus nerve. There are many programs for this, and they are probably the most effective tool for support (more than any pill/diet)! I’ve had some report significant improvements within just one week of starting a program! Programs I recommend include:
- The Gupta Program (20-60 min a day); free trial available
- Primal Trust (multiple options for membership)
- Annie Hopper’s programs (e.g. DNRS, weekend seminars, book) (60+ min of commitment daily)
- Frequency Specific Microcurrent therapy
- Dr. James Jealous‘ Biodynamic Osteopathy or the Cranial Academy
- Brain Tap (developed by Dr. Patrick Porter)
- Dr. Steven Porges’ Safe and Sound (sound-based therapy to support vagus nerve)
- Support: At least weekly if not daily include someone in your life who is supportive, such as a mindfulness-based therapist or counselor, practitioners and/or health coaches that believe you and advocate for you, and family/friends that listen to you without judgement.
What we put on our bodies affects our health!
- Start with the Environmental Working Group, and aim to get all cleaning products, topical products (shampoos, lotions, makeup, etc) under a “4” according to the EWG.
What touches the food we consume:
- Limit plastic use to frozen items, and change all other storage containers to glass, and make sure plates/glasses don’t have lead, and cooking pots/pans are stainless steel, ceramic, or cast iron.
Keep the air you breathe as clean as possible, for both indoor and outdoor air.
- Our pituitary (a “master gland” in the body) is near our nasal passages, and play a huge role in immunity (and thus mast cell activity). Consider a good quality air filter such as Air Doctor or Austin Air in the bedroom and office (or the 2 most common locations where you spend your time), clean air ducts at least once a year, clean drapes/curtains a few times a year, and keep HVAC cleaned with yearly maintenance.
Consider the role of EMFs (electromagnetic frequencies) i.e. wifi (stimulate mast cells); we’re all exposed to these daily, but there are ways to reduce exposure
- Start by limiting electronic stimulation in the bedroom (e.g. turn off wifi at night, no screens in the room including tablets, phones, and TVs).
- Wifi or EMF sensitivity: See this podcast for more information
- Consider purchasing a Tri-Field Meter to identify where you may be getting high exposure to electromagnetic fields in your home/work
Nutrition: Trial of a low-histamine diet (for recipe ideas, I recommend the book “The 4-Phase Histamine Reset Plan” by Dr. Becky Campbell). If no improvements, even small improvements, within 3-4 weeks on this plan, do not continue (histamine from the diet doesn’t always trigger mast cell symptoms – can be other molecules released by mast cells that are the cause of symptoms!).
- Focus less on foods to avoid, and more on adding foods for support. For example, some examples of foods that can REDUCE histamine include: Collard greens, zucchini, arugula, onion, fresh/dried herbs, apples, blueberries, pomegranate, egg yolk, apple cider vinegar, white rice. Additional list of foods found here.
- Many with MCAS get immune “PTSD” to foods, so consider using supportive therapies like a PTSD neurofeedback machine (I learned about the benefits of this from Jaban Moore DC who uses a Clear Mind machine to help someone get out of a PTSD state).
- Some really sensitive patients, if weight loss isn’t a concern, may do better with periodic liquid fasting and even a “carnivore” diet (these definitely need to be supervised by a practitioner)
Water: Many chemicals can trigger mast cells, and tap water (or low quality filtered water) has many chemicals that can be triggers. I recommend drinking good quality filtered water – some of my favorite filters include Berkey and Clearly Filtered. Many filters remove beneficial elements, so I also recommend adding mineral drops (these also reduce acidity of the water). My go-to brand is BodyBio, found on Fullscript.
Stress/Relaxation: Stress is a significant trigger of mast cells, so a daily relaxation habit is key to helping calm mast cells.
- A big part of this is supporting and stimulating the vagus nerve (and/or make sure the structure of the vagus nerve is not impaired, e.g. in the neck or near diaphragm); some examples include EFT (Emotional Freedom Technique), acupuncture, gentle craniosacral work, or working with a functional neurologist
Sleep: Mast cells have a “circadian rhythm”, and good sleep routine/quality is essential to restore normal activity.
We have multiple receptors (i.e. “locks”) that histamine binds to, but only 2 classes of medicine to bind to H1 and H2 receptors. Since histamine is one of the molecules that mast cells release, many with mast cell hyperactivity can experience symptom reduction with anti-histamines.
However it can take 6 weeks to truly notice a significant difference, and if there’s no improvement within this time frame I recommend switching to another anti-histamine for a total of 3-4 treatment trials (since there’s slight difference between each anti-histamine, so they don’t act the same in everyone). If no improvement after trying multiple anti-histamines, histamine may not be a primary trigger of symptoms.
- H1 Blockers up to 3x/day: Examples include Allegra (least likely to cause sedation), Zyrtec, Claritin (weakest but may be best to start with if sensitive, some reports have found intra-vaginal use to be helpful for vaginal pain), Xyzal (particularly good if skin issues are present)
- H2 blockers: Examples include Tagamet, Pepcid, Zantac before meals (I mainly recommend these if gut symptoms are present)
- Diphenhydramine (Benadryl): I prefer Genexa brand (cleaner brand, can use for burning mouth and may help in compounded suppository form for vaginal pain and interstitial cystitis)
- Hydroxyzine (also has anti-anxiety effects, can help with sleep)
- Rupatadine (partially blocks mast cells, PAF inhibitor as well) (must be obtained from Canadian pharmacy since not available in the US)
- Hydroxyzine (great for insomnia as well)
- Some psychiatric medications show anti-histamine and mast cell stabilizing effects, per Dr. Mary Beth Ackerley:
- Fluvoxamine, lower dose often preferred (anti-mast cell, appears to be antiviral and improve blood flow, anti-inflammatory by stopping cytokine production); may be useful in OCD, tinnitus, PANS
- Mirtazapine, low dose with low dependency risks (helps with weight gain, food reactions, sleep)
- Nortriptyline (H1, H2, H3 blocker; good for pain especially with LDN, migraines, sleep)
- Seroquel and trazodone also have some anti-histamine actions
- Red sage
- CBD (even as suppository)
- Stinging nettles (anti-inflammatory; one of my go-to recommendations, starting with tea)
- Moringa (strong anti-histamine actions)
- Spirulina (some anti-histamine actions)
- Zatidor eye drops (can use in saline for nasal rinse as well)
- Nasochrom (nasal spray)
- Bacopa moniera before meals (Bacopa works similar to prescription cromolyn)
- Nettle tea (2 oz before meals; brewed for 15 min can make an infusion aka stronger tea)
- Quercetin: 250mg to 3000mg daily; can be more effective with meals
- Note that the brand matters, since the cheapest source of quercetin is peanut and fava beans (fava beans can affect those of Mediterranean descent who lack G6PD); for example, if supplement isn’t bright yellow, it’s not going to be effective
- Higher levels can cause dysbiosis (since only 10% of bioflavonoids can be absorbed)
- Luteolin (bioflavenoid that is an Histamine-3 receptor blocker as well); good for “brain and gut” symptoms (sourcing for this is key, though, to be effective!)
- Rutin (bioflavenoid): Often in combination with other ingredients; a quercetin glycoside (acts like a slow-release quercetin)
- PEA (palmitoylethanolamide) – up to 3 grams daily; particularly good for “brain” symptoms
- AllQlear – Tryptase inhibitor: Taken before meals (less commonly effective, but taste good!); not a mast cell stabilizer per say, but works on one of the molecules (tryptase) released by mast cells
- Gastrocrom: Taken before meals; many with MCAS may be sensitive to the extra ingredients in this so may need to get a compounded prescription
- Compounded cromolyn sodium: Nasal form can help brain fog, some individuals have used for tinnitus (aka ringing) in the ear; some practitioners use compounding pharmacies to use this as a nebulizer
- Compounded Ketotifen (orally or nasal use) 0.25-6mg up to 3x/day; also a H1 receptor blocker; good for those with hives and skin rashes
- Singulair (but may cause depression/anxiety in some)
- LDN (low dose naltrexone) 0.25-4.5mg: Particularly good for those with pain, brain fog, and if taken with alpha lipoic acid (ALA) can help neuropathy
- Less commonly used by studied in research:
- Omalizumab aka Xolair (for hives in particular)
- NeuroProtek or PureLut before meals (developed by Dr. Theoharides; have luteolin)
- Resveratrol Supreme (this has quercetin as well)
- SunBalance (has PEA, luteolin, and quercetin) before meals
- HistaminX by Seeking Health
- NeuroFlam NT by Apex Energetics (has luteoline, Chinese skullcap)
The chemicals that mast cells release are “excitatory”, and the following act opposite of this (aka “calming” or “inhibitory”):
- Micronized progesterone
The brain and nervous system is always involved in MCAS, and the following can support healthy neuron and cell membranes:
- Bioactive lipids:
- Phosphatidylcholine (PC), up to 5 grams daily (tastes terrible!): Most effective when combined with butyrate. Also good for bile. Can combine taurine, glycine and choline for less expensive option.
- CBD (ideally organic), particularly effective for anxiety, sleep, and pain
- PEA: Particularly beneficial when combined with luteolin and CBD per Mary Beth Ackerley MD
- Butyrate (best used with PC)
- Stress (mental and physical): Stress releases CRH (cortisol releasing hormone) which stimulates mast cells and VEGF release
- Strenuos exercise
- Excess estrogen or high estrogen fluctuations associated with period (e.g. birth control, hormone replacement therapy)
- Optimize Gut Health: Daily well-formed bowel movements are essential. Constipation will make mast cell hyperactivity worse by affecting the vagus nerve, which is the nerve that connects gut to the brain
- Something to consider is how prescription drugs may be affecting health when histamine intolerance or MCAS is suspected, such as the commonly prescribed drug metformin which has been shown to block break down of histamine by diamine oxidase (DAO)
- Methylation support:
- Vitamin B12: I prefer hydroxycobalamin over methylcobalamin, though, for those with MCAS (methyl-form can be stimulatory)
- Methlated folate or folinic acid
- Vitamin B6
- Betaine TMG
- Creatine, particularly around exercise
- Skullcap (baicalin): Chinese or American; particularly good for sleep, anxiety, and lowering inflammation
- Boswellia (anti-inflammatory)
- Glutathione support (e.g. NAC, glycine)
- Magnesium (glycine, threonine, taurine): Many need up to 1000mg or more
- Probiotics, sometimes high dose if tolerated (particularly those that don’t contribute to histamine, such as those found in ProBiota HistaminX, from Seeking Health)
- L. rhamnosus
- Spore based
- DAO Enzymes to help breakdown histamine from food; can also use desiccated kidney supplements in place of this, such as Heart & Soil or Ancestral Supplements
- Vitamin D3/K2
- Vitamin A (retinoid form)
- BPC157 (great for the gut, collagen e.g. in EDS)
- Thymosin (appears to be particularly helpful for immune balance)
- KPV (appears to help mast cells in particular)
- Off-label use of prescription hydroxyurea (for those with bone pain)
Bodywork and alternative therapies (particularly helpful for supporting vagus nerve)
- Functional neurology
- Lymphatic drainage (massage, vibration plate, dry brushing, jumping on rebounder)
- Fascial counterstain
- Qigong, Tai Chi
- Somatic experiencing to work through trauma (body physically holds onto trauma)
- Visual therapy
- Craniosacral work
- Osteopathic manipulation
- Gentle chiropractic care (no forceful adjustments), e.g. Network, Blaire technique, NUCCA
- Coffee enemas
According to Dr. Lawrence Afrin, MCAS is likely under-diagnosed and more prevalent than we originally thought – up to 17% of the population in America may have it. Addressing MCAS takes time, patience, and work, but feeling better is possible!
With my personal experience, and to echo the words of Dr. Neil Nathan, MCAS is a “consequence” of another issue (not an isolated symptom). There are treatments for support, but addressing the nervous system via the limbic system (involved in any sensitivity, and the emotional response to illness) and vagus nerve (key part of the “rest and digest” nervous system) are key aspects of treatment that cannot be skipped (but do take work!). Essentially, these set the body up to receive treatment by telling the body that it’s “safe” to take. And I’ve even seen people heal completely just with these programs!
At the end of the day, however, a diagnosis is just a label that should guide treatments. If the questionnaire suggests MCAS, talk to a knowledgeable healthcare practitioner about treatment options. There aren’t many in mainstream medicine, but they may help!
If you want personalized guidance for treatment while also looking for the suspected causes, I highly recommend seeking the guidance of a functional medicine professional. Beyond myself and my colleagues at Parsley Health, I’ve provided a few people below who may have additional educational resources or who may be a good practitioner to work with one-on-one.
- Mast Cell Activation: A Primer for the Gastroenterologist
- Utility of hydroxyurea in mast cell activation syndrome.
- Efficacy and toxicity of hydroxyurea in mast cell activation syndrome patients refractory to standard medical therapy: retrospective case series
- Pharmacologic treatment options for mast cell activation disease.
- Mast cells, mastocytosis, and related disorders (NEJM).
- Mast cell activation syndrome: Proposed diagnostic criteria.
- The relationship between mast cell activation syndrome, postural tachycardia syndrome, and Ehlers-Danlos syndrome.
- Video on the “Pentad Super Syndrome”
- Histamine in the nervous system.
- The role of mast cells in neuroinflammation.
- Mast cell activation disease: An under appreciated cause of neurologic and psychiatric symptoms and diseases.
- The effects of plant flavonoids on mammalian cells: Implications for inflammation, heart disease, and cancer (co-authored by Dr. Theoharides)
- Luteolin supplements: All that glitters is not gold
Clinicians that provide more education on MCAS, and often treat patients with MCAS:
- Lawrence Afrin MD (one of the leading researchers and practitioners who specialize in MCAS)
- Leonard Weinstock MD (gastroenterologist based in Missouri)
- Becky Campbell DNM, DC (specializes in histamine intolerance)
- Theo Theoharides MD, PhD (one of the leading researchers in MCAS)
- Andrew Maxwell MD (pediatric cardiologist who specializes in dysautonomia)
- Beth O’Hara (MastCell360.com)
- Selective serotonin reuptake inhibitors suppress mast cell function.