Mast cells (also known as a mastocytes) are type of white blood cells and essential cells of the immune system. They are localized in the tissues which are in direct contact with the environment, such as the skin, digestive, and respiratory systems. Therefore, mast cells abnormalities result in symptoms presented in several body systems.
Mast cell diseases are caused by excessive production and accumulation of genetically altered mast cells (as in mastocytosis) and/or inappropriate mast cell activation (as in Mast Cell Activation Syndrome, MCAS). Each person suffering from MCAS, or another mast cell abnormality may respond to different triggers, have different symptoms, and show variability in the severity of symptoms. In severe cases, performing daily tasks may become a challenge. about mast cells, their function, and disorders I wrote in my previous blog post here.
The most common drugs prescribed for the treatment of MCAS include antihistamines, mast cell stabilisers and inhibitors (e.g., cromolyn), tyrosine kinase inhibitor, non-steroidal anti-inflammatory drugs (helpful for some, a trigger for others), benzodiazepines, or selective serotonin reuptake inhibitors (Akin et al., 2010). Unfortunately, some of these drugs block the enzyme that breaks down histamine (diamine oxidase, DAO), which triggers its accumulation in the body and increases severity of symptoms. In addition, people affected by MCAS are often sensitive to compounds in drugs like fillers, binders, and dyes. Therefore, it is important to use natural remedies to treat MCAS.
Many patients find that natural treatments are sufficient to treat their MCAS. For others, natural methods allow them to reduce the amount of medication they need. The most effective treatment for MCAS is based on several steps. The main ones include:
1. THE USE OF GLUTEN-FREE AND LOW-HISTAMINE DIET
Studies have shown that eliminating gluten- and histamine-containing foods can significantly improve symptoms (Son et al., 2018; Lackner et al., 2019). It is therefore important to avoid e.g., alcohol, processed foods with synthetic preservatives, colours, flavour, and aroma enhancers, smoked, pickled, and fermented foods, vinegar, soy sauce, dairy products, yeast, certain vegetables (avocados, tomatoes, aubergines, spinach), and certain fruits (citrus fruits, bananas, strawberries). Furthermore, activated mast cells can be silenced by increasing the dietary fibre intake (Folkerts et al., 2018).
2. AVOIDANCE OF MCAS TRIGGERS
It is important to eliminate all triggers (Akin et al., 2010) which include infections (bacterial, viral, parasitic, fungal, and moulds and their biotoxins), chemicals in personal and household products, chemical food additives (such as preservatives, artificial colourings, flavour enhancers), fragrances (e.g., perfumes, paints), extreme temperatures, emotional stress and other mentioned in my previous post here. By doing that, people with non-aggressive forms of MCAS usually notice an improvement within the first few weeks of treatment.
3. STABILIZING MAST CELLS
Inhibition of the release of inflammatory mediators from mast cells can be achieved by increasing intake of flavonoids and polyphenols such as quercetin (naturally present in onions, broccoli, apples, grapes, blueberries), resveratrol (in dark grapes, blueberries), apigenin (in parsley, chamomile, celery, artichokes, oregano), luteolin (in celery, parsley, broccoli, onions, carrots, peppers, cabbage, apples), and silymarin (the main active ingredient in a standardised extract of milk thistle seeds) (Choi and Yan, 2009; Finn and Walsh, 2013; Shaik et al., 2018; Bilotta et al., 2021).
4. IMPROVING GUT AND LIVER FUNCTION
Intestinal dysbiosis, leaky gut syndrome and inflammatory bowel conditions contribute to a reduction of the histamine-degrading enzyme, DAO (Honzawa et al., 2011; Schink et al., 2018). To help regulate the gut flora and regenerate the intestinal mucosa it is important to take and pre- and probiotics. Since most probiotics contain histamine-producing bacteria (e.g., Lactobacillus acidophilus, L. casei), patients should use supplements containing strains that reduce histamine production or help with histamine breakdown e.g., Bifidobacterium infantis, B. longum, Lactobacillus rhamnosus, L. gasseri. Liver and bile duct diseases also contribute to MCAS. Therefore, it is important to improve the function of these organs with a suitable diet and herbs like milk thistle (Silybum marianum) and barberry (Berberis vulgaris).
5. TREATING EXISTING INFECTIONS
To help the body stabilize the mast cells it is necessary to treat any existing infections (bacterial, viral, parasitic, fungal). Herbs, preferably selected individually for the type of infection, will be extremely helpful in this regard.
6. SUPPLEMENTING IN CASE OF DEFICIENCIES
An adequate supply of vitamin C, B6 and zinc is important to reduce histamine level. However, one should use vitamin C which is not produced by fermentation or from the citrus fruits. Supplementation with the enzyme DAO can also be used when necessary. Omega-3 fatty acids can help to reduce inflammation. Alpha lipoic acid, N-acetylcysteine, selenium, and vitamin B12 seem also to be useful in case of overactive mast cells.
7. SUPPORTING RECOVERY WITH HERBS
Curcuma longa (turmeric) has been shown to decrease symptoms of food allergies and inhibit mast cell release (Baek et al., 2003; Shin et al., 2015). Scutellaria baicalensis (skullcap) aid in immune cell regulation, helping to retrain the inflammatory cascade. Skullcap and Urtica diocia (nettles) have anti-allergic effects (Jung et al., 2012; Bui et al., 2017). Althaea officinalis (marshmallow) and Ulmus rubra (slippery elm) can be used to heal the irritated gut mucosa. Marshmallow has even been found to have anti-inflammatory effects. Nervous system trophorestorative herbs will help to calm overactive nervous system and increase resilience to stress. This, in turn, will indirectly decrease mast cell activity. Some herbs to consider using include Avena sativa (oat), Verbena officinalis (vervain), and Matricaria chamomila (chamomile).
8. REDUCING STRESS AND GETTING ENOUGH SLEEP
Stress is one of the activators of mast cells and release of inflammatory mediators. Working on reducing stress levels (via meditation, light exercises) and getting enough sleep are therefore important in the treatment of MCAS.
CONCLUSIONS
Mast cell activation disorders are characterized by accumulation of genetically altered mast cells and/or abnormal release of these cells' mediators, affecting functions in potentially every organ system, often without causing abnormalities in routine laboratory or radiologic testing. Luckily, there are several natural approaches to help stabilize mast cells and modulate the immune system. The mast cells are adaptable and, with the help of herbs, supplements, and lifestyle modifications, patients can reclaim their health. It is important to start the treatment slowly and work towards therapeutic dosing of supportive herbs and supplements.
REFERENCES
Akin C, Valent P, Metcalfe DD. (2010). Mast cell activation syndrome: Proposed diagnostic criteria. J Allergy Clin Immunol. 126(6):1099-1104.
Baek OS, Kang OH, Choi YA, Choi SC, Kim TH, et al. (2003). Curcumin inhibits protease-activated receptor-2 and -4-mediated mast cell activation. Clin Chim Acta. 338(1-2):135-141.
Bilotta S, Paruchuru LB, Feilhauer K, Köninger J, Lorentz A. (2021). Resveratrol is a Natural Inhibitor of Human Intestinal Mast Cell Activation and Phosphorylation of Mitochondrial ERK1/2 and STAT3. Int J Mol Sci. 16;22(14):7640.
Bui TT, Piao CH, Song CH, Lee CH, Shin HS, Chai OH. (2017). Baicalein, wogonin, and Scutellaria baicalensis ethanol extract alleviate ovalbumin-induced allergic airway inflammation and mast cell-mediated anaphylactic shock by regulation of Th1/Th2 imbalance and histamine release. Anat Cell Biol. 50(2):124-134.
Choi YH, Yan GH. (2009). Silibinin attenuates mast cell-mediated anaphylaxis-like reactions. Biol Pharm Bull. 32(5):868-75.
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Folkerts J, Stadhouders R, Redegeld FA, et al. (2018). Effect of Dietary Fiber and Metabolites on Mast Cell Activation and Mast Cell-Associated Diseases. Front Immunol. 9:1067.
Honzawa Y, Nakase H, Matsuura M, Chiba T. (2011). Clinical significance of serum diamine oxidase activity in inflammatory bowel disease: Importance of evaluation of small intestinal permeability. Inflamm Bowel Dis. 17(2):E23-5.
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Lackner S, Malcher V, Enko D, Mangge H, Holasek SJ, Schnedl WJ. (2019). Histamine-reduced diet and increase of serum diamine oxidase correlating to diet compliance in histamine intolerance. Eur J Clin Nutr. 73(1):102-104.
Schink M, Konturek PC, Tietz E, Dieterich W, Pinzer TC, Wirtz S, Neurath MF, Zopf Y. (2018). Microbial patterns in patients with histamine intolerance. J Physiol Pharmacol. 69(4).
Shaik Y, Caraffa A, Ronconi G, Lessiani G, Conti P. (2018). Impact of polyphenols on mast cells with special emphasis on the effect of quercetin and luteolin. Cent Eur J Immunol. 43(4):476-481.
Shin HS, See HJ, Jung SY, Choi DW, Kwon DA, Bae MJ, Sung KS, Shon DH. (2015). Turmeric (Curcuma longa) attenuates food allergy symptoms by regulating type 1/type 2 helper T cells (Th1/Th2) balance in a mouse model of food allergy. J Ethnopharmacol. 4;175:21-29.
Son JH, Chung BY, Kim HO, Park CW. (2018). A Histamine-Free Diet Is Helpful for Treatment of Adult Patients with Chronic Spontaneous Urticaria. Ann Dermatol. 30(2):164-172.
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