Mast Cell Activation Syndrome: A Primer for the Gastroenterologist
Abstract
Mast cell activation syndrome is thought to be a common, yet under-recognized, chronic multi-system disorder caused by inappropriate mast cell activation. Gastrointestinal symptoms are frequently reported by these patients and are often mistaken by physicians as functional gastrointestinal disorders. This syndrome can be diagnosed by the medical history and measurable biomarkers. Gastroenterologists manage diseases associated with active inflammatory cells including neutrophils, lymphocytes, macrophages, and eosinophils. The mast cell has only recently been recognized as a major player in our specialty. Gastrointestinal disorders from mast cell mediators often present with apparent irritable bowel syndrome, dyspepsia, chronic or cyclical nausea, and heartburn. Individuals with mast cell activation syndrome experience significant delays in diagnosis. The gastrointestinal symptoms are often refractory to symptom-targeted prescription medications. Beyond avoiding triggers, the best therapy is directed at modulating mast cell activation and the effects of the mediators. Many of these therapies are simple over-the-counter medications. In this article, we review mast cell function and dysfunction and the gastrointestinal symptoms, comorbid conditions, diagnosis, and management of mast cell activation syndrome. Gastroenterologists who become aware of this syndrome can dramatically improve the quality of life for their patients who previously have been labeled with a functional gastrointestinal disorder.
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Some patients with POTS have symptoms suggestive of abnormal mast cell activation.
“Some patients with POTS have symptoms suggestive of abnormal mast cell activation.”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [25]
Alternative diagnostic criteria for MCAS often lack specificity and validation.
“Alternative diagnostic criteria of MCAS have also been suggested, but these alternative criteria often lack speci fi city and validation.”
From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [34]
Alternative criteria related to the diagnosis of MCAS are much broader and less specific for MCA or MCAS.
“These criteria are much broader and less speci fi c for MCA or MCAS.”
From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [34]
Alternative approaches with less stringent criteria result in an expanding group of individuals being labeled as having MCAS who exhibit a wide range of symptoms claimed to be attributable to MCA without clear relation to MCs or attributes of anaphylaxis or MCA.
“Such alternative approaches with less stringent criteria result in an expanding group of individuals being labeled as having MCAS, but who exhibit a wide and nearly unlimited range of symptoms claimed to be attributable to MCA without clear relation to MCs or attributes of anaphylaxis or MCA.”
From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [34]
Some authors have based the diagnosis of MCAS on a variety of clinical symptoms that may or may not relate to mast cell activation.
“Some authors have based the diagnosis of MCAS on a variety of clinical symptoms that may or may not relate to MCA. 31,34”
From Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review (2021) · cites this paper as [34]
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“There is considerable concern regarding the consequences of overdiagnosing MCAS by using less stringent and less specific criteria.(31,34) For example, when including an elevation of mediators relatively specific for MCs, it is also important to define thresholds and especially the event-related further minimal thresh…”
BackgroundMethodInfluentialMastocytosis and Mast Cell Activation Disorders: Clearing the Air
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Mast cell activation may explain many cases of chemical intolerance
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Additional file 1 of Mast cell activation may explain many cases of chemical intolerance
Miller, C. S., Palmer, R. F., Dempsey, T. T., Ashford, N. A., & Afrin, L. B. (2021) · Figshare · doi:10.6084/m9.figshare.17037309
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Woestemeier, A., Semaan, A., Block, A., Arensmeyer, J., Dohmen, J., Kania, A., Verrel, F., Mücke, M., Kalff, J. C., & Lingohr, P. (2023) · Figshare · doi:10.6084/m9.figshare.24425633
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Outcome measures in long COVID clinical trials: a review
van Rhijn-Brouwer, F. C. C.-C., de Canson, C., VanDerNagel, J., Westerhuis, X., Young, S. Y., van Kuijk, S. M. J., de Vries, L. V., van Rhijn, J.-R., & Hellemons, M. E. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1972605
- Authors
- Weinstock, L. B., Pace, L. A., Rezaie, A., Afrin, L. B., & Molderings, G. J.
- Affiliations
- University of Utah (US)
- Cedars-Sinai Medical Center (US)
- University Hospital Bonn (DE)
- Corresponding author
- Weinstock, Leonard B.
- Venue
- Digestive Diseases and Sciences
- Published
- 2020-04-23
- Volume
- 66
- Issue
- 4
- Pages
- 965-982
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- OpenAlex
- W3020784083
- Semantic Scholar
- 1bce28cc497e890e8ebadc8d0ecadf5dcd4755dc
- Cited by
- 59
- References
- 79
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 9 · 2023: 14 · 2022: 9 · 2021: 10 · 2020: 5
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD085852)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- mast cell activation syndrome, mast cell activation, gastrointestinal symptoms, irritable bowel syndrome, dyspepsia, chronic nausea, heartburn, functional gastrointestinal disorders, mast cell mediators, biomarkers, diagnosis, treatment, over-the-counter drugs, comorbidities, delayed diagnosis
- MeSH terms
- Diagnosis, Differential, Gastrointestinal Diseases, Humans, Mastocytosis, Quality of Life, Disease Management
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