NZNancy
Tutor
Offline
I Love YaBB 2!
Posts: 35
|
The article is: Mast cell activation syndrome: Proposed diagnostic criteria; Cem Akin MD PhD, Peter Valent MD, Dean D Metcalfe MD; Journal of Allergy and Clinical Immunology 2010 (my copy was pre-publication so I don't have issue and page number)
There are many diseases that involve mast cell activation. "Primary" mast cell activation is seen in mastocytosis and "monoclonal mast cell activation syndrome"; these involve mast cells that are abnormal and self-activated.
Secondary activation of mast cells is the result of various stimuli acting on (apparently) normal mast cells. For instance, allergic disorders, mast cell activation due to chronic inflammatory disorders or tumors, urticaria triggered by heat or cold or exercise, chronic autoimmune urticaria. some infections activate mast cells.
Idiopathic disorders, where there may be activation of mast cells, or the symptoms may be caused by activation of other immune system cells instead, such as basophils or macrophages or others. These could include idiopathic anaphylaxis, idiopathic angioedema, or idiopathic urticaria.
OK, so those secondary causes of mast cell activation need to be ruled out along the way to making a diagnosis of "Mast cell activation syndrome". They are mast cell activating disorders, though.
The proposed criteria for the diagnosis of MCAS, then, follow:
1. Episodic symptoms consistent with mast cell mediator release and affecting 2 or more organ systems, for example a. Skin: urticaria, angioedema, flushig b. Gastrointestinal: nausea, vomiting, diarrhea, abdominal cramping c. Cardiovascular: hypotensive fainting or near fainting, tachycardia (rapid heart rate) d. Respiratory: Wheezine e. Naso-ocular: redness and swelling of the conjunctiva, itching, nasal stuffiness
2. A decrease in the freuency or severity or resolution of symptoms with antimediator therapy (H1 and H2 antihistamines, antileukotriene medications (Singulair, Zyflo), or mast cell stabilizers (cromolyn, ketotifen)
3. Evidence of an increase in a urinary or blood serum marker of mast cell activation: increase of tryptase level above baseline on 2 occasions or only once if the baseline level of tryptase is 15ng/ml or higher. This is the preferred method of indicating mast cell activation. Less specific markers are 24-hour urine with elevated level of histamine metabolite or prostaglandin metabolite, PGF2.
The point is to establish a definite diagnosis for MCAS, separating it from the other mast cell activating disorders.
I'm interested in knowing how many people in this group can pursue this diagnosis.
Nancy
|