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What are mast cells?

Mast cells are another name for mastocytes.  Mast cells are loaded with a number of different types of inflammatory mediators, including histamine, heparin, and serotonin.  They also contain interferon, interleukin, leukotrienes, prostaglandins, eosinophilic chemotactic factor, and other inflammatory agents.  When mast cells are activated (triggered), they discharge these inflammatory mediators by a process known as degranulation.  The release of these proinflammatory agents results in the classic allergy symptoms with which we are all familiar (watery eyes, nasal discharge, and sneezing, sometimes accompanied by a rash, or hives, and/or itching).  These chemicals generate inflammation by dilating the blood vessels, increasing the permeability of capillaries, and promoting increased mucus production.  The inflammation causes redness and swelling of the inflamed tissue, and it attracts other inflammatory cells to the site.  Mast cells play a key role in the inflammatory process because they are the cells that usually initiate the first inflammatory response.

Mast cells are white blood cells, and they are derived from bone marrow.  They're relatively large cells, of two different types, one type found in connective tissue, and another type found in mucosal tissue.  Mast cells associated with connective tissue can be found in various parts of the body, and they are the type found in the skin, for example.  Mucosal mast cells are located in the intestines, lungs, mouth, nose and vagina.  Those in the intestines are located just below the mucosal intestinal barrier, where they are in a prime position to be activated by either bacterial or food-associated antigens.  So it's not surprising that mast cells can have a major effect on the digestive process by means of immune system events that occur within the digestive system.  But in addition to this, inflammatory events initiated by mast cell degranulation in one part of the body can result in associated issues in other parts of the body.  For example, a mast cell reaction that is triggered in the mouth by a certain food, can result in a secondary reaction in the intestines, with only a very slight time lag between the two events.

Mast cells are coated with IgE, which, like all antibodies, are specific to one particular antigen, though IgG responsess are also possible.  When triggered by the appropriate antigen, they immediately degranulate, to initiate inflammation.  In cases of extreme sensitivity, they can cause anaphylactic symptoms that may result in a life-threatening situation (constriction of airways to cause breathing difficulties, flushing, tachicardia, drastically reduced blood pressure, and related symptoms).  Though mast cells may be known primarily for creating allergy and anaphylaxis symptoms, they also play an important part in the defense of the body against pathogens, and they are involved in the wound-healing process.

In the case of mucosal mast cells, in addition to activation by means of IgE or IgG atibodies, they can also be activated by T lymphocytes1.  It appears that the lymphocytes typically associated with mast cell events are eosinophils and macrophages.  And since mast cells typically surround blood vessels and nerves, in locations that serve as boundaries between organs of the body and the outside world, they are very responsive to activation stimuli, and the inflammation modulators that they release tend to provoke a rapid response in the body, due to their easy access to the bloodstream and the nervous system.  That's why IgE-based reactions can progress so rapidly.  It is believed that 2 or more IgE molecules must bind to a mast cell (known as cross-linking) in order for activation to occur.  However, under certain conditions, it appears that mast cells are able to degranulate for no apparent valid reason, and/or certain people develop histamine-related symptoms for reasons that are not obvious.  This condition is known as mast cell activation syndrome (MCAS), or mast cell activation disorder (MCAD).  And it seems that certain individuals are more sensitive to histamine than others, so that when a certain threshold is exceeded, symptoms appear.  This means that some people will suffer symptoms of a histamine reaction, even though both their histamine level, and their mast cell count may be normal.  As William Alford described in 2005:2

There is also the mast cell activation disorder. In this case either a greater or even a normal number of mast cells may be “twitchy” or too easily activated by stimuli and may even be activated by autoantibodies. For these patients, symptoms may appear from the release of mediators when a histamine threshold has been reached. If one thinks of a “histamine bucket” representing some critical level at which symptoms appear, then any addition to this “bucket” is a burden that commands attention. When some cumulative load from stress, environmental activating stimuli, endogenous histamine, and ingested histamine cause the bucket to “overflow”, then the appearance of symptoms can manifest. Patients whose symptoms wax and wane over time may fall into this category as their histamine “load” varies with circumstance. (p. 1)

Research shows that trauma or other direct injury, which can be in the form of either a physical or a chemical insult, can also cause the degranulaton of mast cells.3, 4  It is known, for example, that opioids, alcohols, and certain antibiotics can cause mast cells to degranulate.  Mast cells can be stimulated to degranulate by direct injury (e.g. physical, or chemical {such as opioids, alcohols, and certain antibiotics such as polymyxins}), cross-linking of Immunoglobulin E (IgE) receptors, or by activated complement proteins.

It's interesting to note here that both gluten and casein contain chemical compounds that mimic opiate-based drugs (such as heroin and morphine) that are known to react with opiate receptors in the brain.5  But in addition to the observation that this implies that gluten and casein can elicit an actual addiction response in the brain (which is often reported as withdrawal symptoms by celiacs when first starting gluten-free diet), there is another important point to make here.6  Since opioids can trigger mast cell degranulation, then it isn't much of a stretch of the imagination to realize that the gliadorphins in wheat, rye, barley, and oats, and the casomorphin in casein (found in all dairy products), can also cause inflammation by directly triggering mast cell degranulation in the intestines.  Note that this is totally independent of the way that food sensitivities typically produce inflammation (by promoting the production of antibodies, which in turn initiates a sequence of immune system events).

Mastocytosis is a rare condition that involves widespread overproduction of mast cells.7  Two forms exist, cutaneous and systemic.  Cutaneous mastocytosis affects only the skin, whereas systemic mastocytosis involves multiple organs.
 While a few people who have microscopic colitis do indeed have mastocytosis, in the vast majority of cases, the mast cell issues associated with microscopic colitis are well below the level of involvement found in true mastocytosis.

Coordinated Involvement of Mast Cells and T Cells in Allergic Mucosal Inflammation: Critical Role of the CC Chemokine Ligand 1:CCR8 Axis.

2. Mast cells and GI motility disease. Unpublished raw data

3. IgE, mast cells, basophils, and eosinophils

4. Intestinal handling-induced mast cell activation and inflammation in human postoperative ileus

5. Gluten / casein peptides test

6. Gluten Free Diet and Withdrawal Symptoms

7. The Mastocystosis Society, Inc 

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