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Introduction to mast cells and MCAS

Hey everyone, it’s Sam again! I reached out to you guys via the Facebook community a few weeks ago and got a few requests for information on mast cells and MCAS. I personally don’t have MCAS, so it’s not something I research as intently, but I LOVE immunology and thought this would be a really fun thing to talk about.

Immunology can be a scary subject, even for biologists. It’s very detail-oriented, there are a LOT of things going on, and the scientific community still doesn’t understand a lot about how the players in the immune system work. We do know that the immune system interacts with other parts of the body, like the nervous system (neuroimmunology recently crossed my radar and I’m enthralled!), to cause some interesting effects, so immunology is becoming a hotter and hotter topic for research.


The big player in MCAS is, as the name implies, the mast cell. To understand MCAS, we need to break down what mast cells are and what they do.

These guys are mast cells:

They have a bunch of receptors on their cell surface that let them talk to other cells in the body and receive input from both other cells and the environment they’re in. All those dark purple circles you see in the image above are called granules. Many different cell types have granules in them, and they can hold different types of chemicals (often called cytokines or chemokines) depending on what the cell needs to do. Mast cells usually have granules full of histamine, but they can also hold enzymes that chop up proteins (proteases), neurotransmitters like serotonin, and a bunch of other types of chemical messengers and enzymes. Histamine is the compound we usually talk about when discussing mast cells and allergy, and it makes a lot of different things happen depending on where it’s released.

So….what exactly does histamine do? There are 4 main histamine receptors in the body, and when they’re activated, each one can cause different things to happen. Some are more common in different parts of the body, which is why histamine can trigger different kinds of reactions. From typical seasonal allergy-type reactions or skin irritation to GI symptoms, to nervous system effects like nausea and vertigo, and even anaphylaxis, histamine can trigger a wide range of symptoms which is why MCAS can be difficult to diagnose. Many signs can be relatively benign or nonspecific, but when typical allergy testing comes up negative, it may be time to investigate MCAS.

Keep in mind that the other chemicals mast cells release can cause other things to happen, too. It’s not all about histamine!


So how are mast cells activated? Mast cells have cell surface receptors that can bind allergens, specific classes of antibodies, and signals sent out by other immune cells. When activated, mast cells release their granules, which then break open and release their contents into the local environment and trigger other events to happen.

It isn’t fully understood why mast cells don’t behave normally in MCAS. It’s important to note that MCAS is not the same as mastocytosis, which is characterized by an abnormally high number of mast cells; in mast cell activation syndrome, mast cells are activated too easily and are releasing their contents in situations they typically wouldn’t. Some environmental triggers can stimulate mast cells, like excessive heat or cold, sunlight, mechanical irritation, and chemicals or products on skin. There’s an observed correlation between MCAS, POTS, and EDS that isn’t fully understood.

MCAS is a very involved disorder, and it would take significantly more than just one post to do it justice. Hopefully this quick overview was helpful! Don’t hesitate to reach out to me via the EDS, Wisconsin Inc. contact page, or on the EDS & Joint Hypermobility Wisconsin Facebook page if you have anything in particular you’d like for me to discuss in detail.


*Disclaimer: I am not a physician, and I am not qualified to give anyone advice about their medical condition. All posts written by me are strictly meant to inform and empower patients and medical professionals alike, with the information they can use to better communicate with each other. If you have questions about your condition, please ask your doctor.


Citations:

  • Mast cell secretory granules: armed for battle. Wernersson S, Pejler G. 2014. Nature Reviews Immunology. 14: 478-494.
  • Mast cell activation syndrome: a review. Frieri M, Patel R, Celestin J. 2012. Current Allergy and Asthma Reports. 13(1): 27-32.
  • https://tmsforacure.org
  • http://www.mastcellaware.com
  • Mast cell activation syndromes. Akin C. 2017. Allergy and Clinical Immunology. 140(2): 349-355.
  • Misbehaving Mast Cells in POTS and Other Forms of Dysautonomia – https://vimeo.com/246313546 (I didn’t actually watch this, but thought it would be a great resource!)

 

Have you heard the news?

Prevention Genetics and Advanced Tele-Genetic Counseling (ATGC) joined us at our latest event, Meagan’s Walk for EDS Awareness and Suicide Prevention and shared in announcing our amazing news.

EDS Wisconsin, Inc. has worked to make genetic testing more accessible, through telephone counseling and self-administered testing.  This can eliminate the long wait, often years, many people face trying to get an appointment and testing with a geneticist.

In honor of the latest news, we’ve created a resource page specifically for genetics resources that we’ll be updating as more information becomes available.

Check it out, share, and don’t forget to print your referral form below!

 

Like, share, and comment!

We can’t wait to hear your reactions!

I’ve written in the blog a few times about my love of Taylor Swift, so if you caught the context of my title as a song lyric, props to you. In this case, you also hopefully caught that we’re playing with today’s holiday.

It’s Mother’s Day and that means we are celebrating all things mom. Here at EDS Wisconsin, many of us have shared and sought feedback about what our moms were like, what it means to be a mom to an EDS kid, and what Mother’s Day means to us. I asked my mom, Janell Armstrong, a few questions this morning and if I could write about her in my blog—mostly because I remember vividly what dealing with my health was like as a child and now that I’m 27, I wanted to hear what that was like from her perspective. So, I asked my mom the hardest part of raising a child who was clearly ill with SOMETHING but un-diagnosed.  Then, I asked my mom the hardest part about having a child get diagnosed with an incurable condition at 25—and changing all of those things that happened in my youth.

My diagnosis story is LONG and I’ve written about it a few times in this blog. The first time I dislocated a joint fully, I was only 12 years old. I had no idea what a dislocation was, but I did know that my kneecap was on the back of my leg—and I was thoroughly convinced it would stay there forever. I don’t know if I’ve ever

My Mom and Stepdad, Dave

, to this day, screamed the way I did that day or shed as many tears. It was an incredibly hot summer day and the knee immobilizer was AWFUL for a child, not to mention that even though I always thought crutches looked “fun,” they were actually really awful to use and I had no clue how to use them.  That really didn’t seem like a big deal, though. Kids get hurt. You all know this. If you have a kid who didn’t end up on crutches at least once in their childhood, consider yourself.

 

The problem is, it didn’t stop. It never stopped. The dislocations got more frequent in that knee as I got older.  I would hurt other joints, too and cry until my mom would take me to the emergency room—and I’m realizing now that I’m four paragraphs in that I failed to mention that my mother, superhero that she is, was raising four kids all by herself.  I begged my mother not to make me go to school. I begged her not to make me go to gym class. I would cry for actual hours while she put ice packs on various parts of my body.

My mom did a lot of things for me most parents don’t have to do—and sometimes she took heat for it. I had a predetermined number of days off school I could take off every month because sometimes I just couldn’t handle school. There were times I sprained my wrist so badly I couldn’t write my own homework even though I came up with all the answers myself—and when I asked the teacher if that was okay, she told me, in front of the entire class, that she would have found a way to write the homework herself, so she was going to take a few points off. I have a feeling she and my mom talked about those points because I never lost them. I was a straight-A student and I wanted teachers to like me, so when they didn’t because I couldn’t do something, it hurt even more than my body did.

Then, there were the doctors. The first time a doctor told me I only hurt because I was fat, I was six years old. The same doctor told my sister blue eye shadow was “slutty” when she was 10, so I’m not quite sure where she went to medical school…but anyway now I’m WAY off topic…hopefully you’re laughing.  By the time the dislocations were happening every day, multiple times a day, I was tumbling down stairs—a LOT. My mom told me this morning that what she felt more than anything with doctors when I was a kid was helplessness. She felt helpless to get answers, helpless to fix me, and helpless to make her child better. She wrote, “You SO want to believe that the next doctor will be able to fix it. I had a tendency to believe them because they are supposed to know more than you! And if this, this, and this happens, it will all be over and your child will be all fixed. It’s a little better now with online resources, but honestly, when you were going through all of it, I didn’t really know where to go besides the doctor to get answers.”

I never heard my mom say until today that she thought the same things I did. “This, this, and this and your child will be all fixed” is neither scientific nor eloquent—but it is what moms of an un-diagnosed child desperately want. It’s what those children want even more. I felt guilt over making my mom take me to the doctor over and over again only to be told they didn’t know or I was fine or this surgery would fix it all—and then it never did.

Here’s how I remember it, though, when the doctors didn’t help me enough, my mom didn’t stop. She never, ever stopped. That lesson stuck with me. I didn’t stop either. When I was 23, I saw another doctor who didn’t help me enough, so I didn’t go back. It happened again when I was 24. Then, when I was 25, a doctor FINALLY told me why I was in so much pain, why I was so sick, why I was the way I was—and suddenly every single trip to every single doctor all those hours away was worth it, because we never gave up.

My mom’s response to my diagnosis question hit me harder than I thought it would, because I wish she didn’t have to feel how she did or does. She explained that it killed her a bit when she found out. She wrote that she questioned every decision she ever made regarding my care. She wrote about guilt for not doing a better job and not pushing doctors. She wrote about the worse guilt about those moments when she doubted her own child’s pain.

So, this is for my own mom—and for any other mom who couldn’t get their child diagnosed until adulthood. These words are my words for you, my thoughts for you, my love letter to the “mama” who made me strong enough to live through EDS:

  • You are not a doctor. You are taught to trust doctors with your lives. A doctor brought me into this world and you trusted them to help you care for me every step of my life. You pushed. You kept pushing—and you gave me the tools to keep pushing once I left the nest. I am my own greatest advocate because I learned from watching you.
  • I doubted my own pain more than you ever could or ever will. I thought for sure it was all in my head. There was no way doctors could possibly go thirteen years and find nothing if I was actually ill, right? You don’t have to carry guilt for wondering about something I couldn’t help but wonder myself.
  • You didn’t make me sick. You made me strong. You gave me all of the wonderful and beautiful things about myself and without EDS, I probably wouldn’t have been able to make these traits what they are today. I will work harder to remind you of that for the rest of my days with you.
  • Watching your child in pain and not being able to help is probably worse than being in pain yourself. You’ve told me so many times that you wish you could just take my pain. I know you mean that. I know you would ACTUALLY do that for me. I know that you would give up walking yourself if it meant I could keep walking. That’s how much you love me. That’s how much you have always loved me. (And some days, I’m selfish enough to let you.)

My mom’s point about not having resources to help her is exactly the reason I do what I do. She is the reason I speak publicly when I can. She is the reason I write this blog and share my story on social media, because I promise you there is a mother out there somewhere with a daughter crying from her pain and the mother does not know what to do—and if I can help one more mother not have to question the decisions she made because she read OUR story (mine AND my mom’s), I will keep doing it for as long as I can.

To all of the mothers raising children with chronic illnesses or who have chronic illnesses themselves, you are strong and brave and wonderful and even though you deserve recognition every day, you especially deserve it today. Happy Mother’s Day.

 Love you, Mom.

Together we are stronger!