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The MastAttack 107: The Layperson’s Guide to Understanding Mast Cell Diseases, Part 4

I have answered the 107 questions I have been asked most in the last four years. No jargon. No terminology. Just answers.

8. Why are symptoms not the same for everyone?

  • Bodies are very complex. This sounds silly to say because of course bodies are complex, but the amount of work a body does on a second to second basis is staggering. All of your organs are working all the time. The way they are working depends on hormones, how recently you ate, if you are stressed out, what kind of environment you live in, if you have been or are pregnant, how old you are, if you are sexually active, where you are in your menstrual cycle, what medications you are on, and what things happened to you up to this point in your life. Not everyone’s body does the same things.
  • Mast cells are involved in regulating many processes at the same time that all of these things are happening. It is releasing chemicals to make these things happen and is receiving messages from other cells.
  • Mast cells are key cells in inflammation. Inflammation is when cells from the immune system tell the body that it is under attack. Some of those cells are white blood cels that were already present. Inflammation causes many white blood cells, including mast cells to go to the site of the inflammation. For example, if you break your arm, the cells near the broken bone will send messages that it needs help from immune cells. Those immune cells will then physically move to the place they were called to. Mast cells may move to the site of inflammation in this way.
  • When an area has been inflamed, sometimes white blood cells stick around even when the area is healed or healing. Mast cells can also do this. If an area is inflamed, you may end up with many mast cells in that spot where there had originally only been a few.
  • When an area has been inflamed, the immune cells nearby can be extra easy to activate for a while. They are “primed”. Primed cells are much more likely to start a new inflammatory episode, even for something tiny, because they are easier to activate. They remember that they previously had to call for help so their instinct is to do it again. In this way, old injuries may “act up” easily. This can keep nearby mast cells primed or even activated long term.
  • Mast cells have pockets called granules that store chemicals inside them. These chemicals are called mediators. They perform many of the mast cell’s normal functions.
  • Mast cells have different jobs in different places in the bodies. The mediators stored inside those pockets are not the same in all mast cells. They are full of the mediators that they need most to do specific jobs in that area. Mast cells can also make new mediators to do specific jobs. The mediators they make are also tailored to their specific jobs.
  • Some mediators are very specific and some are not. Think of this like sending an email. You can send an email to a particular person. This is specific. You can also send an email to an address used by many people, like an email account for several people who work in customer service. Any of them might see it and respond but you don’t know which one. This is nonspecific. Mast cell mediators might talk to just one type of cell or to several kinds of cells, either nearby or in other parts of the body. Which mediators are released can also depend on previous inflammation. Which mediators are released, where they are released, and how much is released also vary from person to person.

9. Why do symptoms change over time?

  • Symptoms can change over time for all of the reasons they are not the same from person to person.
  • It is also possible that symptoms can change due to progression of disease from one diagnostic category to another. For example, patients may suddenly notice their abdomen is swollen and hard. That could be because their liver is swollen and not working properly.
  • You CANNOT assume that the disease is progressing because symptoms change. Symptom change is NOT a marker for progression.
  • Mast cell disease is not inherently progressive. Many people never have a change in diagnosis.

For more detailed reading, please visit these posts:

The Provider Primer Series: Management of mast cell mediator symptoms and release

The Provider Primer Series: Mast cell activation syndrome (MCAS)

The Provider Primer Series: Cutaneous Mastocytosis/ Mastocytosis in the Skin

The Provider Primer Series: Diagnosis and natural history of systemic mastocytosis (ISM, SSM, ASM)

The Provider Primer Series: Diagnosis and natural history of systemic mastocytosis (SM-AHD, MCL, MCS)