Marianne Russo and The Coffee Klatch produced an important interview this week. If you have a child with autism, OCD, anxiety, allergies, inflammation, trauma-related cognitive deficits or depression you may wish to listen.

Several years ago when Dr. Theoharis Theoharides (Dr. Theo) from Tufts University, was researching a disease called Mastocytosis, he noticed a high co-occurrence of Autism in subjects. Through a simple survey it was found that 10% of people with Mastocytosis also had an ASD diagnosis. This compelled Dr. Theo to do testing of children with autism that lead to the discovery that some autistic children had activated Mast cells.  New research suggests that mastocytosis can present as psychiatric illness as well.

Systemic mastocytosis is a disease characterized by an excessive accumulation of mast cells, and associated with skin lesions, flushing, diarrhea, tachycardia, and psychiatric manifestations. In order to define more clearly the psychiatric manifestations, ten patients with this disorder underwent unstructured psychiatric interviews and a battery of psychologic testing. Both revealed a pattern of cognitive and affective changes in the majority of these patients, best categorized as an atypical or mixed organic brain syndrome.

The cognitive changes consisted of diminished attention and memory, and the affective changes of anger, irritability, and, to a lesser extent, depression. These manifestations fluctuated with the level of disease activity, and appeared in some cases to respond to histamine antagonists and disodium cromoglycate, medications used to control the excessive mast cell activity. It is important for psychiatrists to be aware that mental status changes can represent psychiatric manifestations of mastocytosis, a readily treatable medical disorder.

It is also possible that sport-related or accident-related traumatic brain injuries can activate over-production of mast cells as well.  More research is needed.

What Are Mast Cells?

Mast cells are “master regulators” of the immune system. They come from bone marrow and go into all tissues of the body. Each mast cell contains secretory granules (storage sacs), each containing powerful biologically active molecules called mediators. These can be secreted when mast cells are triggered, leading to allergic and inflammatory diseases.

What Do Mast Cells Do?

Mast cells are located in connective tissue, including the skin, the linings of the stomach and intestine, and other sites. They play an important role in helping defend these tissues from disease. By releasing chemical “alarms” such as histamine, mast cells attract other key players of the immune defense system to areas of the body where they are needed. Mast cells seem to have other roles as well. Because they gather together around wounds, mast cells may play a part in wound healing. For example, the typical itching felt around a healing scab may be caused by histamine released by mast cells. Researchers also think mast cells may have a role in the growth of blood vessels (angiogenesis). No one with too few or no mast cells has been found, which indicates to some scientists we may not be able to survive with too few mast cells.

What is the Problem with Mast Cells?

Mast cells are unique immune cells present in all tissues; they are mostly found in the dienchepalon of the brain that controls emotions. Mast cells act as “alarmins” to environmental, infectious and stress insults. When we think of Mast Cells, we often think of skin issues, because when too many Mast Cells accumulate they cause skin conditions.  But one can also get Systemic Mastocytosis, which may increase inflammation and allergies.  It can even create cognitive symptoms such as brain fog.

What Does My Physician Need to Know?

Therapy for systemic mastocytosis (systemic mast cell disease) is primarily symptomatic; no therapy is curative. First, know some of the symptoms. Treatment modalities include the management of (1) anaphylaxis and related symptoms, (2) pruritus and flushing, and (3) intestinal malabsorption. The principles of treatment include control of symptoms with measures to decrease mast cell activation. Find more on treatment here.


MastCell Aware

Dr. Theo

Low Histamine Chef

Dr. Theoharis Theoharides has also found that supplements and a low-histamine diet may help. Research is ongoing.