Triggers
Triggers are anything which causes mast cell activation . Diary keeping is a good
tool to identify triggers . In Mastocytosis the mast cells are triggered by any
substance , not just proteins as is common in allergy . By any means – IGE ,
other immuno globulins , compliment , individual mechanisms . Allergy can exist
in mastocytosis as the same rate as in the general population . The allergy will be
magnified disproportionate to IGE level .
Hints of trouble :- labile BP – Bp varying with minimal movement ( fluid moving ) ,
reduced exercise tolerance ( slow walking ) .
This is the list from tmsforacure.org – The mastocytosis society in the US ;-)
Alcohol
Anesthetic agents
Antibiotics - mycin antibiotics
Bacteria or fungi
Certain foods
Cold (temperature)
Coloring & flavoring in foods
Coloring & flavoring in medications
Emotional upset
Environmental toxins
Exercise or exertion
Fatigue
Fever
Friction
Heat (temperature)
Infection with viruses, bacteria or fungi
Mold
MSG
Narcotics
Perfumes
Pesticides
Plasma expanders (i.e. dextran)
Preservatives
Room freshener sprays
Smells
Spices
Stress
Sunlight
Examples of manifestations – No 2 patients are the same in their triggers
Infection – worst when getting ill and when recovering
Hormones – mid month and when due on 34 day cycle -
Emotional stress ( extreeme )- flush , burn – up to full symptoms
Exercise – swelling moving up body , up to throat and chest
Physical stress , operations , tiredness – itching , swelling – up to full
symptoms
Sulphites – see naughty list ( acidic based pathway in lungs leads to
broncoocnstriction , up to full symptoms quickly .
Caramel colouring – E 150 a-d - up to full symptoms , quickly
Corn flour – bowel swelling , spasms and bleeds . frequency and pain – up to
full symptoms on empty stomach
Geltine – flush ++++ burning and wheeziness ++++
Alcohol in anything inc meds , gells , cleaning products , personal care
in blood / drank = quick / full symptoms .
Vinegar again in anything – bowel spasms , frequency , bowel histamine travel =
full symptoms
Heat – dizzy , flush , drowsy – up to full symptoms. Sit under fan 24/7
Low blood sugar – agaitated , shaky , flush , itch , swell – up to full symptoms
High blood sugar – flush , swell , up to full symptoms
High cholesterol – increases number and severity of attacks
Air fresheners – itching mouth face , throat – up to full symptoms
Sulphite fumes from cooking – itching mouth face throat , chest tighten / fill – up
to full symptoms
BBQ fumes – same
DIY stores – polystyrine and paint – hot , flushed , confussed , dizzy , passout
Diesel fumes in traffic – hot , flushed , nausated , vomit – up to full symptoms
Blue powder used for cleaning in hospitals – itchy mouth / face , chest
wheeziness
All spray cleaners , cream cleaners – itchy mouth throat , tounge swell ,
voice drop – full symptoms
Examples of IGE allergies
Pollen – itch , flush , hot +++ , drowsy while pollen high , chest symptoms
Cats – itch , flush , throat close . traveling cat hair makes me itch
.
House dust – itch flush , swell – full symptoms
Opiates bar codines – itch , vomit +++ , bowel swell
Personal care – No sodium leureth sulphate in products inc toothpaste , no
gelatine , corn flour or sulphites . – itchy , alochol / sulphites give rash then
absorbed slowly causing chest tightness , short of breath , blue , if ihaled –
wheezy
Drugs – Absolute NO’s
CT contrast – iodine
Clexane – low molecular weight heparins , Heparin of any kind
Mycin antibiotics
Ciprofloxicillin
Metroclopamide
Meptid
Plasma expanders
Medical examinaton gel , ecg stickers ( caution will flush )
Beta blockers ,- calcium channel blockers are alternative of choice . Pulse
is commonly fast due to histamine
Tricyclic antidepressants – mix poorly with epipens – VT VF
SSRI’s – changing patients serotonin level leads to increased symptoms .
Some patients have high serotonin , which with ssri , will give a serotonin
syndrome
Opiates - Pethididne , Morphine , Fentnyl , buprenmorphine
Full list of drug issues in mast cell disease ;- and levels of histamine which cause
different symptoms
http://www.iainfoctr.com/articles/histamine.php
Cautions
If alcohol / sulphites are an issue the following may be an issue
All thrush treatments inc nystatin
Any capsules – gelatine , corn flour . Check pills for corn flour , Maize starch , pre
gelatainised corn starch / flour / miaze starch . modified maize starch
Check liuqids for – maltilol, Asulphamine K ( potassium ) , caramel colouring
E150 a-d , ascetic acid / viniger . Alcohol.
Beware hand cleaning Alcohol, skin wipes .( Alcohol )
Anesthetic guide on this memory stick alongside articles regards symptoms .
Day to day considerations
High fluid intake - to keep up with fluid loss from fluid moving into tissues through
porous blood vessels as an effect of histamine in mastocytosis , This is before
infection or hyperglycemia or hot weather . Patient can lose 2l of circulating
volume before swelling is visable in skin .
Only water , fresh- not from concentrate orange juice or tea
Fresh milk
Natural high histamine time – 2 am
Patient should avoid high histamine foods
http://www.iainfoctr.com/articles/histamine.php