My Preferred Approach for Moderate to Severe MCAS/Histamine Intolerance
There are two primary things that have prompted me to develop my current approach to MCAS. First being that most of my clients who have MCAS or histamine intolerance are on the more severe end of the spectrum. Second, a bias I’ve developed from my own experience with MCAS (and seeing others in the same boat) wherein I did not respond to conventional nor integrative medicine approaches to MCAS.
Nonetheless, here is my approach in a nutshell.
1. Potent and Systemic Antiinflammatories / Nervous System Support
This stage does not involve supplements. It may involve prescription anti-inflammatories, peptides or other depending on the person, their access to the items we discuss and their comfort level. The goal is to reduce reaction enough that the client can have a better subjective sense of what food, supplements or lifestyle pieces help or hinder them.
MCAS is a nervous system disorder. We have mast cells and histamine receptors throughout the nervous system. Most MCAS clients are stuck in sympathetic nervous system activation due to this. I provide multiple options for parasympathetic support, but if a client is unable to tolerate more than 12 foods, or has a history of trauma it can be a good idea to start with the Gupta program or another Limbic System Retraining program.
2. Antihistamines and Mast Cell Stabilizers: (herbal, over the counter, or prescription)
Antihistamines are a band-aid solution, but they can help reduce the severity of symptoms, which can help clients feel less overwhelmed. The choice between herbal or non-herbal antihistamines depends on the person. If you feel that you are reacting to herbs it may be better to use non-herbal antihistamines. And if you can’t tell what you are reacting to I would recommend doing the Cell Sciences sensitivity panels, which can include common herbs, medications, foods and supplements.
Keep in mind that antihistamines won’t fully even block the effects of histamine at your receptors. You have four histamine receptors and most antihistamines block either histamine receptor 1 and 2. Don’t use antihistamines thinking they’ll resolve all your symptoms. Most antihistamines also have consequences if used long-term. You can either avoid long-term use or discuss methods for mitigation of long-term side effects.
Herbal antihistamines might include pycnogenol, black seed, quercetin, PEA, PQQ - depending on which MCAS phenotype they are or which enzyme pathways are blocked. (see upcoming blog post for phenotypes)
I do also consider binders as herbal antihistamines, because they can reduce histamine at the gut barrier level.
3. Barrier Support and Immune Regulation (Leaky Gut and Immune Hypervigilance)
Healing the mucus layer is one of the most under-appreciated parts of resolving leaky gut in my opinion. When the body heals trauma to the mucus layer it requires: amino acids, Peptide growth factors, hormones (LnRH), cytokines, IGF-1, EGF, TGFα and β, PDGF, Growth Hormone and GHRF.
This is why many leaky gut protocols and products contain amino acids or utilize growth hormone and other peptides.
Research has demonstrated Colostrum can be one of the most comprehensive forms of support due to it containing Vits A and D, peptides, immunoglobulins, IGF and growth hormone.
I personally like and use goat colostrum because I've found that some can be sensitive to beef products. See HERE for specific product.
I recommend alternating with Marshmallow Root and/or peptides.
Relevant assessments for gut barrier function include:
Lactulose/mannitol urine test
Vit D and A levels
Zinc levels
Protein absorption
4. Less potent antiinflammatories plus immune regulating probiotics:
This is where Aloe, Boswellia, curcumin and fever-few come in. I often find we can’t necessarily introduce many supplements before the antiinflammatories have kicked in. But, these options can be used longer term.
FeverFew or other bulk herbs can be purchased HERE with our discount ROSELOVE15.
I might start clients with a Bacillus coagulans probiotic - Thorne makes a single strain version. I recommend clients start by opening the capsule and taking a pinch each day - working up to a full capsule. This strain should be taken with food or after a meal.
5. When clients are feeling more stable we can start to address root causes.
For example, mold, metals, microbiome imbalance and blocked enzyme pathways. You can save a lot of time by having done a good genetics test combined with a nutrient panel or OAT to compare which enzymes are actually running fast or slow. In my experience, it isn’t just the DAO, HNMT or histamine direct pathways that promote MCAS, but rather MCAS can be promoted if any of the pathways related to detoxification are bottlenecked. For example, in my case, the ammonia pathways were upregulating inflammation for me and causing degranulation.
