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How do I know if mast cells are causing problems for me?

As discussed in the previous article (How are mast cells associated with microscopic colitis?), research shows that approximately 70 % of people who have an inflammatory bowel disease show elevated mast cell numbers in the mucosal lining of their intestines.  And as discussed in the article before that one (What are mast cells?), mast cells often degranulate inappropriately and cause symptoms for no apparent reason (known as mast cell activation disorder or MCAD), even when their numbers are normal.  So clearly, whenever treatments that are normally successfully used for treating microscopic colitis fail to bring relief, it may be time to consider the possibility that mast cell issues are also involved, and they may be preventing us from reaching remission.

There are often certain clues to tip us off when mast cells are involved.  For example, since mast cell degranulation usually results in an IgE-based immune system reaction within a few minutes after exposure to a problem food, we may notice symptoms such as watery eyes, a runny nose, itching, throat congestion, flushing, or the sudden appearance of a rash on the face or upper body, within 10 or 15 minutes after eating a food to which we are sensitive.  These symptoms are often triggered by mast cell degranulation in the mouth or esophagus.  Any one or more of those symptoms is an indication of a food-related mast cell problem.  

In some cases, the advent of symptoms may be delayed for several hours or more, until the food has had time to travel farther down the gastrointestinal tract.  In this situation, the delayed reaction suggests that the symptoms are associated with the degranulation of mast cells in the intestines.  And the additional symptoms of diarrhea, gas, and a headache may be present.

In fact, research shows that too much histamine in the diet can trigger these symptoms even in normal people who don't have a digestive system disease.  Quoting from the book Microscopic Colitis:1

To demonstrate the potential effects of histamine in food, a double-blind, placebo-controlled crossover study was conducted in 2004, in which healthy subjects with no prior history of food sensitivities ingested either plain peppermint tea or peppermint tea in which the equivalent of 75 mg of histamine had been dissolved.2 None of the subjects reacted to the placebo, but half of them reacted to the histamine challenge. 40 % of them experienced symptoms such as diarrhea, gas, headache, itching, and eye issues after ingesting the tea that contained the histamine. To put this into perspective, some of the foods that have a high histamine content can contain as much as 500 mg of histamine per kg, so an ordinary meal can easily contain a higher dose of histamine than was used in this research study.

Other symptoms associated with mast cell issues include mouth sores, fever blisters, and itchy bumps on the scalp or elsewhere on the skin.  Symptoms such as these may seem unrelated to microscopic colitis, but actually they are rather commonly associated with the disease, and they are the direct result of inappropriate mast cell degranulation, and/or too many foods with a high histamine content in the diet.  An increased heart rate soon after eating is another symptom of mast cell issues.  Even frequent urinary tract infections can be an indication of mast cell problems associated with microscopic colitis, in some cases.

1. Microscopic Colitis

2 Histamine intolerance-like symptoms in healthy volunteers after oral provocation with liquid histamine

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