Unmasking Mast Cell Activation Syndrome (MCAS): A Root-Cause Approach to a Widely Misunderstood Condition
Mast Cell Activation Syndrome (MCAS) is one of the most under-diagnosed and poorly understood conditions in modern healthcare. Patients with MCAS often endure years of symptoms labeled as “anxiety,” “IBS,” or “unexplained allergies” before finding relief. Many are bounced between specialists, given patchwork diagnoses, or told their symptoms are psychosomatic. Unfortunately, conventional medicine tends to treat symptoms in isolation, overlooking the intricate web of immune, hormonal, neurological, and gastrointestinal factors that drive chronic inflammation and systemic hypersensitivity.
At Movability, we specialize in uncovering complex, root-cause conditions like MCAS. Dr. Sina and his multidisciplinary team take a systems-based approach, integrating clinical diagnostics, immune profiling, functional lab testing, and hands-on physical assessment to identify and treat the true sources of illness—not just the symptoms.
What Is Mast Cell Activation Syndrome?
MCAS is a condition in which mast cells—a type of immune cell involved in allergic reactions and tissue repair—become dysregulated. Rather than activating appropriately in response to infections or injuries, these cells become hypersensitive, releasing excessive amounts of histamine, prostaglandins, leukotrienes, and cytokines into the bloodstream. This leads to wide-ranging symptoms across multiple systems, often mimicking other chronic disorders.
Diagnostic Criteria for MCAS
To formally diagnose Mast Cell Activation Syndrome, three criteria must be met:
Recurring symptoms involving two or more organ systems (such as skin, gut, nervous system, cardiovascular, or respiratory).
Elevated mast cell mediators, ideally measured during or soon after a flare. These include:
N-methylhistamine (urine)
Prostaglandin D2 (urine)
Leukotriene E4 (urine)
Chromogranin A (blood)
Tryptase (blood), although this is often normal in MCAS
Clear clinical response to medications that block or stabilize mast cells. These include H1 and H2 antihistamines, leukotriene inhibitors, or mast cell stabilizers like cromolyn.
This “three-pillar” model is consistent with international consensus guidelines from organizations such as the European Competence Network on Mastocytosis (ECNM) and the American Academy of Allergy, Asthma & Immunology (AAAAI).
Mast Cell Biology: A Hidden Player in Systemic Health
Mast cells are found throughout the body: in the skin, gastrointestinal tract, respiratory system, blood vessels, and even the brain. They respond to a variety of stimuli, including allergens, infections, temperature changes, emotional stress, and even certain medications. When triggered, mast cells release mediators that regulate inflammation, blood vessel permeability, nerve sensitivity, and immune response. In MCAS, these responses are amplified and dysregulated, resulting in symptoms that are often puzzling to both patients and practitioners.
Common Symptoms of MCAS (and What Clinicians Often Miss)
MCAS doesn’t look the same in every patient. Symptoms can wax and wane and vary from one body system to another. This makes it notoriously difficult to recognize. Many MCAS patients are misdiagnosed with anxiety, fibromyalgia, chronic fatigue syndrome, IBS, POTS, or unexplained hypersensitivities.
Multisystemic Symptom Clusters
Skin: Flushing, itching, hives, dermatographism, unexplained rashes
GI: Bloating, diarrhea, acid reflux, cramping, food intolerances
Cardiovascular: Tachycardia, dizziness, near-syncope (especially in POTS overlap)
Respiratory: Wheezing, nasal congestion, throat tightness
Neurological: Brain fog, migraines, tingling, mood swings, sleep disturbances
Urogenital: Interstitial cystitis, pelvic pain, urinary frequency
Diagnostic Red Flags Often Overlooked
Symptoms that worsen during hormonal fluctuations (such as menstrual cycles)
Reactions to fragrances, temperature changes, alcohol, or medications
Negative allergy tests despite allergy-like symptoms
Chronic GI issues unresponsive to dietary interventions
Sudden onset of POTS-like symptoms without a clear cause
How MCAS Presents Across Age Groups
MCAS doesn’t present the same way in everyone—and symptoms often vary depending on age and hormonal stage. This is one of the reasons it’s so frequently missed.
Children (0–12 years)
Common signs include chronic stomach aches, vomiting, eczema or rashes, irritability, frequent infections, unexplained flushing, and sensitivity to medications. MCAS in children is often misdiagnosed as behavioral disorders, food allergies, or “sensitive stomach.”
Adolescents (13–18 years)
Hormonal shifts during puberty often exacerbate symptoms. Teens may develop migraines, fatigue, brain fog, lightheadedness, panic attacks, new-onset food intolerances, or skin issues. Many girls experience flares around ovulation or menstruation, and are misdiagnosed with anxiety or PMDD.
Adults (19–64 years)
In adulthood, MCAS commonly mimics IBS, fibromyalgia, interstitial cystitis, chronic fatigue, autoimmune symptoms, and unexplained allergic reactions. Patients may report heat intolerance, food reactions, hives, or dizziness. Many have seen multiple specialists without a unifying diagnosis.
Older Adults (65+ years)
In seniors, MCAS may masquerade as cardiovascular, neurologic, or cognitive decline. Symptoms like hypotension, bladder urgency, memory changes, or sensitivity to new medications may be dismissed as “aging,” when they’re actually due to age-related shifts in mast cell regulation and increased sensitivity to triggers.
Common Comorbidities and Overlap Syndromes in MCAS
MCAS often coexists with other chronic conditions. In fact, recognizing patterns of overlap is often the key to finally connecting the dots.
Hypermobile Ehlers-Danlos Syndrome (hEDS)
These patients often experience joint hypermobility, chronic pain, and poor connective tissue integrity. Mast cells in the fascia and joints may become chronically activated from mechanical stress, leading to inflammation and widespread reactivity.
Postural Orthostatic Tachycardia Syndrome (POTS)
Histamine and prostaglandins released by mast cells can dilate blood vessels and destabilize autonomic function. Many POTS patients report overlapping symptoms like flushing, nausea, and food sensitivity that improve with mast cell therapy.
Endometriosis and Hormone-Sensitive Pain
Estrogen triggers mast cell activation, which may contribute to endometrial lesion growth, pelvic inflammation, and cyclic flares of pain, migraines, or GI distress. Progesterone tends to calm mast cells, explaining why some patients respond better to certain forms of hormonal therapy.
Interstitial Cystitis (Bladder Pain Syndrome)
The bladder wall contains mast cells that can trigger pain, urgency, and burning even in the absence of infection. MCAS should be considered in patients with negative cultures but persistent symptoms—especially if symptoms respond to antihistamines.
Irritable Bowel Syndrome (IBS) and Gut Dysbiosis
Mast cells lining the gut influence motility, permeability, and sensitivity. Patients with MCAS often meet IBS criteria but do not improve with fiber or probiotics. Low-histamine diets, antihistamines, and gut healing protocols are more effective in these cases.
Chronic Fatigue Syndrome (ME/CFS)
MCAS and ME/CFS often overlap. Mast cell mediators can disrupt sleep, lower energy, impair mitochondrial function, and increase inflammatory load. Treating MCAS may reduce post-exertional crashes and brain fog in CFS patients.
Autoimmune Conditions
MCAS is not autoimmune, but it may amplify autoimmune flares through cytokine release and barrier dysfunction. Hashimoto’s, lupus, and Sjögren’s often coexist with mast cell dysregulation.
Migraine and Neurological Hypersensitivity
Histamine and prostaglandins sensitize nerves and dilate vessels in the brain. MCAS-related migraines, tinnitus, and sensory overwhelm often improve with mast cell stabilizers, DAO supplementation, and dietary changes.
Multiple Chemical Sensitivity (MCS) and Toxicant-Induced Loss of Tolerance (TILT)
Patients who become reactive to perfumes, smoke, cleaning products, or VOCs may actually have mast cell dysregulation triggered by prior exposures. This is immune sensitization—not psychological—and is often reversible with proper treatment.
Why Conventional Treatments Fall Short
The conventional model tends to address each symptom separately—antihistamines for allergies, PPIs for reflux, SSRIs for anxiety, and so on. This fragmented approach fails to address the root dysfunction: mast cell dysregulation and the factors perpetuating it.
Most physicians are not trained to identify MCAS unless the patient is in anaphylaxis. Even when MCAS is suspected, tryptase is often the only marker ordered—and it’s frequently normal. Without urinary histamine, prostaglandin D2, leukotriene E4, and related mediators, MCAS remains hidden in plain sight.
Movability’s Root-Cause Approach to MCAS
At Movability, we approach MCAS from the inside out. We don’t treat it as a label to manage. We treat it as a signal that something deeper in the system is driving inflammation, nervous system sensitivity, and immune dysregulation. Our goal is to identify and correct that root cause.
We use everything available in-house—functional diagnostics, manual therapy, clinical nutrition, movement re-education, nervous system support, and naturopathic care—to address the layers contributing to mast cell instability. Our team integrates these therapies into one streamlined plan, built around what your body and history are telling us.
What Makes Our Approach Different
We don’t just suppress symptoms. We investigate the why behind your reactivity.
Is it mold toxicity? Connective tissue dysfunction? Trauma imprinting? Gut dysbiosis? Hormonal swings? Post-infectious immune dysregulation? Our team maps these connections through a deep, layered assessment and co-creates a treatment strategy that works from the ground up.
How We Work With Your Doctor
Because pharmaceuticals like H1 and H2 blockers, cromolyn, ketotifen, leukotriene inhibitors, or low-dose naltrexone require a medical prescription, we collaborate directly with your family doctor or specialist to ensure you get what you need.
If you don’t have a physician who is familiar with MCAS, we’ll write a comprehensive letter summarizing our findings, explaining your symptom pattern, and clearly outlining the rationale for specific medications or referrals. If imaging, lab testing, or a specialist consult is necessary, we guide your doctor on what to order and why. This open line of communication ensures your care is cohesive, integrated, and medically sound.
Whether you need a neurologist, an allergist, a rheumatologist, or a gastroenterologist, we direct the process so nothing gets missed and no one is working in isolation.
Our In-House Process: From Discovery to Resolution
MCAS is not a surface-level condition. It is a symptom of deeper systemic dysfunction that varies from person to person. Our process at Movability is designed to identify what is driving the mast cell hyperactivity in your body and to support the systems most affected—immune, nervous, digestive, hormonal, structural, and emotional.
Everything begins with a deep, clinician-led case review that considers your full medical history, symptom triggers, prior testing, life events, environmental exposures, and even patterns from childhood.
From there, we use functional diagnostics—advanced lab testing and clinical assessments—to look for the overlooked.
Functional Diagnostics We Use In-House
Our licensed naturopath can order a range of private, specialty lab tests to identify underlying causes that are commonly missed in the standard medical model. These labs are particularly useful in MCAS cases, where conventional markers like tryptase may be normal, but chronic immune stress is still present.
Examples of Functional Testing Include:
Mast cell mediator panels (urinary N-methylhistamine, prostaglandin D2, leukotriene E4, chromogranin A)
Comprehensive stool analysis and SIBO breath testing
Urinary mycotoxin testing for mold exposure (facilitated via your MD or NP)
Organic acids testing for mitochondrial function and detox pathways
Salivary and urine hormone panels (estrogen, progesterone, cortisol, DHEA, melatonin)
Nutrient and inflammatory markers (Vitamin D, B12, iron, CRP, homocysteine)
IgG and immune reactivity food panels when clinically relevant
These labs give us the data needed to map your inflammatory triggers, histamine load, immune function, detox capacity, and hormonal regulation—allowing us to tailor treatment precisely.
Supportive Therapies Offered at Movability
Clinical nutrition and supplement strategies: quercetin, luteolin, PEA, vitamin C, DAO enzymes, magnesium bisglycinate
Manual therapy: fascial release, craniosacral therapy, lymphatic drainage, vagus nerve stimulation
Nervous system regulation: breathwork, acupuncture, neuroemotional techniques, body-based trauma resolution
Exercise and movement rehab: tailored strength and mobility plans that respect autonomic and connective tissue sensitivity
Naturopathic medicine: targeted protocols for hormone balance, gut repair, detoxification, and resilience building
We address what we can within our scope and make sure the rest is handled properly through medical channels. The result is a care plan that is not only holistic, but also medically complete.
Contact Movability today to book a comprehensive assessment and experience our results-driven approach.
Please note: Lab fees are not included in the initial assessment. Any recommended lab tests will have their own separate cost.
