MCAS Histamine and Salicylates

Mast Cell Activation Syndrome (MCAS) is a more recently recognised condition characterised by over-activation of mast cells, which are essential for our immune defense. The incidence and prevalence of MCAS may be increasing in many societies perhaps in parallel with other allergic and atopic conditions (1). With MCAS, the immune system reacts abnormally to triggers, including naturally occurring chemicals found in our foods, in some medications, some products used and in our environment. Symptoms may mimic food allergy symptoms. In this post, we will investigate how MCAS relates to histamines (or amines) and salicylates.

What is MCAS?

MCAS is marked by an excessive release of chemicals such as histamine from a special group of white blood cells called MAST CELLS.

Mast cells live longer than other normal cells in our body and are located in the bone marrow (where they grow), the gut, skin and airways. Mast cells are integral to keeping our bodies in balance, called homeostasis, are integral to repair of our body tissue and form an integral part of our immune repsonses. Interestingly, histamine is also involved in the regulation of stomach acid and mood. The issue (MCAS) occurs when mast cell function is not regulated by the body and gets out of control resulting in overproduction of histamine.

The Role of Histamine in MCAS

Histamine is a key player when it comes to mast cell activities. It is one of the main substances released.

When mast cells are not being properly regulated in our bodies, the histamine that is released is excessive to our needs, and if there is inadequate enzyme to help degrade histamine in the body then the problem can be exacerbated. With mast cell disorder, symptoms typically include a number of different systems in the body resulting in different clinical symptoms and signs (see below and infographic). This is likely due to a number of factors

• Mast cells are found through out the body

• There is a wide variety of amines produced in the body, besides histamine, which are integral for normal functioning: such as dopamine, epinephrine, serotonin, melatonin and others important as neurotransmitters, growth regulation, inflammation mediators. The effects of these amines are far reaching.

Common symptoms typically found with MCAS include;

• symptoms suggestive of allergies such as flushing that may increase, decrease, and travel throughout the body

• SKIN: rash, itching, angioedema (swelling under the skin), urticaria (hives)

• CARDIOVASCULAR: hypotension (low blood pressure), tachycardia (fast heart rate), near syncope symptoms (feeling lightheaded, dizzy, weak), blood pressure changes

• RESPIRATORY: wheezing, shortness of breath, difficulty breating, bronchospasmic cough (a sudden tightening of the muscles around the airways, leading to a cough along with other symptoms like wheezing, chest tightness, and shortness of breath)

• NEUROPSYCIATRIC: Headache, migraines, fatigue. lethary, attention deficit, sensory neuropathy, anxiety, and mood disorders

• GYNAECOLOGICAL: Volvovaginitis (an inflammation of the vulva and vagina, typically causing itching, redness, swelling, and unusual discharge), menorrhagia (very heavy bleeding at menstruation), dysmenorrhea (painful menstrual cramps).

• HEAD & NECK: nasal congestion, runny nose

• GUT: nausea, vomiting, reflux, abdominal pain, diarrhea/constipation

• OTHER: fybromyalgic type pain, joint hypermobility, irritation of the eyes, nose, mouth, and throat, lymph node inflammation, interstitial cystitis (frequent and urgent need to urinate)

• Dysautonomia: a condition where the autonomic nervous system, which controls involuntary bodily functions like heart rate, blood pressure, and digestion, malfunctions

Amines: A Key Component

Amines are naturally fund in many foods and in our environment. Amines include a number of related substances, one of which is histamines.

High amine foods usually contain combination of the different amines sub groups, for example:

Chocolate contains several types of amines, including tyramine, histamine, and phenylethylamine, which are naturally present in cocoa and can be formed during processing. Tyramine is the main amine found in dairy products responsible for the so-called “cheese effect”. If you have an amine sensitivity to amines in foods and the environment, then reacting to these amines will result in release of histamine from your mast cells. We are all primed to react to amines in foods when they get to the level you see in food poisoning but if you are amine sensitive, you will react to what should be safe levels in food. If you have an amine sensitivity, then you may also have a glutamate sensitivity as these tend to be present in the same foods.

Reducing intake of high-amine foods can help manage symptoms effectively. If you have an amine sensitivity, you may also have a salicylate sensitivity.

Salicylates: Another Trigger

Salicylates are compounds found in many plants and are recognized for their anti-inflammatory effects. Foods loaded with salicylates include:

• Fruits: such as acidic fruits, think green apples in particular and citrus fruits,

• Vegetables: Including capsicum and kale

• Herbs and spices: Like turmeric and oregano

  
  

For people with MCAS, these compounds can also trigger mast cell activation. Data show that varying percentages of individuals may report adverse reactions to foods rich in salicylates.

Understanding these triggers is vital for those who want to fine-tune their diets to manage their symptoms better.

The Interplay Between Histamine, Amines, and Salicylates

The relationships among histamine, amines, and salicylates create a complex interplay. For example, when someone with amine and/or glutamate and/or salicylate sensitiivty consumes foods high in these compounds, mast cells in their body is triggered to release histamine.

Understanding this cycle is essential for managing symptoms. The connections between MCAS, amines, histamine, and salicylates are intricate and require careful consideration for effective management.

You will get best results for engaging a professional FOOD INTOLERANCE DIETITIAN to guide you through this maze of food chemical intolerances.

Managing MCAS: Reducing Histamines and Salicylates in your diet.

Managing MCAS effectively hinges on dietary choices. Here are some strategies:

1. Identify Triggers: Conduct a food diary to note what you eat and how it impacts your symptoms.

2. Consult Professionals:

Find a General Practitioner or Immunologist who can diagnose MCAS and script mast cell stabilisers

Seek a Specialist Dietitian familiar with MCAS and food chemical sensitivity. We can help create a customised dietary plan, focusing on low-amine/glutamate and low-salicylate options and guide you through this very tricky area.

A colorful assortment of fresh produce, highlighting foods that may contain salicylates.

The Importance of Education and Awareness

Awareness and education are fundamental for those living with MCAS. Understanding the role of histamine, amines, and salicylates empowers individuals to make informed health choices.

Joining support groups or online communities can also offer valuable insights and emotional support. Sharing experiences can help foster a supportive community where individuals learn from each other.

Join my supportive FACE BOOK GROUP: Amines, Glutamates and Salicylates: The Food Intolerance Dietitian.

BOOK NOW TO MANAGE YOUR HEALTH

REFERENCES

(1) Parrish, CR, Mast Cell Activation Syndrome- When it Is and Isn't. Nutrition Issues In Gastroenterology, Series 199, Practical gastroenterology, 2020: https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2020/06/Mast-Cell-Activation-Syndrome-June-2020.pdf

MCAS REFERENCES Özdemir Ö, Kasımoğlu G, Bak A, Sütlüoğlu H, Savaşan S. Mast cell activation syndrome: An up-to-date review of literature. World J Clin Pediatr. 2024 Jun 9;13(2):92813. doi: 10.5409/wjcp.v13.i2.92813. PMID: 38948000; PMCID: PMC11212760. REFERENCES SALICYLATES & MCAS

Rechenauer T, Raithel M, Götze T, Siebenlist G, Rückel A, Baenkler HW, Hartmann A, Haller F, Hoerning A. Idiopathic Mast Cell Activation Syndrome With Associated Salicylate Intolerance. Front Pediatr. 2018 Mar 27;6:73. doi: 10.3389/fped.2018.00073. PMID: 29637062; PMCID: PMC5881244. AMINES IN FOODS

Natrella G, Vacca M, Minervini F, Faccia M, De Angelis M. A Comprehensive Review on the Biogenic Amines in Cheeses: Their Origin, Chemical Characteristics, Hazard and Reduction Strategies. Foods. 2024 Aug 18;13(16):2583. doi: 10.3390/foods13162583. PMID: 39200510; PMCID: PMC11353796.

AMINES IN CHEESE

Natrella G, Vacca M, Minervini F, Faccia M, De Angelis M. A Comprehensive Review on the Biogenic Amines in Cheeses: Their Origin, Chemical Characteristics, Hazard and Reduction Strategies. Foods. 2024 Aug 18;13(16):2583. doi: 10.3390/foods13162583. PMID: 39200510; PMCID: PMC11353796.