I was diagnosed with Systemic Mastocytosis in 1997 I'm also known as a shocker. I'm a 58 year happily married man with three beautiful girls and two step sons and 11 beautiful grandchildren!
The Mastocytosis Society,Inc. Information Sheet for Patients and Caregivers
This is a brief introduction for new patients and doctors who are unfamiliar with the management of mastocytosis. The information presented here, combined with that available in the cited references, provides a starting point from which to approach understanding, treating, and living with this rare disorder.
Mast cell disease, or mastocytosis, is characterized by the proliferation and accumulation of mast cells in a variety of tissues and can affect either sex at any age. Definite diagnosis is made by demonstrating an abnormal accumulation of mast cells in a biopsy, usually of the skin and/or bone marrow. Other causes for symptoms should be ruled out, and blood and urine testing for mast cell products may be suggestive of the diagnosis. When performed properly by experienced personnel with access to current information on recommended protocols the results of these tests will be useful in diagnosing and evaluating mastocytosis.
Mast cells are widely distributed in nearly every organ of the body, mainly close to blood and lymph vessels, nerve endings, and skin and mucous membrane surfaces. They develop from immature cells produced in the bone marrow, which migrate to the tissues where they mature.
Mast cells produce various chemicals which normally serve protective, inflammatory and regulatory functions as they interact with white blood cells and tissues. In mastocytosis these chemicals, or mediators, are abnormally abundant and cause symptoms.
Mast cell products (mediators)
Some mast cell products are stored in granules within the cell, and others are produced in response to stimulation by the immune system or by drugs, chemicals, or physical factors. Below is a table of some factors which can cause mast cells to release their products. Stress, strong emotions and estrogen can increase their effect.
The products present in granules and ready for immediate release on stimulation include histamine, heparin, tryptase, and chymase. These chemicals cause, and to some extent regulate, allergic and inflammatory changes, and are involved in tissue building or repair. In response to immune system activation of the mast cell, arachidonic acid within the cell is converted into prostaglandin D2 and leukotriene C4, which restrict air flow in the lungs, stimulate mucous formation, and attract some kinds of white blood cells.
Mast cells also generate several cytokines, which are proteins that interact with white blood cells and tissue cells to continue the allergic or inflammatory response.
Symptoms
The symptoms of mastocytosis vary from person to person and may occur as "attacks" or as simply fatigue and a feeling of ill health. Over time, symptoms may become more frequent and more severe. The rate of progression differs from person to person, and there may be an improvement in symptoms for long periods of time. The type and severity of symptoms can also vary greatly from person to person or from one episode to the next. Often, seemingly unrelated symptoms comprise an individual's personal pattern of mastocytosis. These may (or may not) include: flushing (temporary skin redness), itching, hives,bruising, and skin sensations such as tingling. Other symptoms experienced by many of the people with mastocytosis are nausea,vomiting, abdominal cramping, occasional or frequent diarrhea, and excess stomach acid or ulcers. The person may experience unexplained fractures, mild to severe pain in bones, joints, or muscles, enlargement of liver or spleen, bladder pain, heart palpitations or rapid heart beat, chest discomfort, shortness of breath, light-headedness, fatigue,weakness, weight loss, respiratory symptoms including asthma. There may be depression, poor memory or irritability; also intolerance to heat or cold or to a change in temperature. Other symptoms include headaches,fainting or near fainting, and recurrent anaphylaxis.
Treatment
Because there is not yet a cure for mastocytosis, treatment is aimed at reducing the frequency and severity of the release of mast cell products and at countering the effects of mast cell products which are inevitably released. Most patients will achieve relief of symptoms only by employing measures in both areas.
Avoidance of the factors which are known to cause a reaction for the individual patient, and cautious evaluation of other factors, such as those listed in the Table below, are important in the management of mastocytosis.
In using drugs to counter the effects of mast cell products,treatment must be tailored to the individual patient. Most commonly, H1 antihistamines such as chlorpheniramine or hydroxyzine are used to decrease the skin symptoms, vasodilation and mucous secreting actions of histamine. Stomach symptoms generally respond well to H2 antihistamines, such as cimetadine or ranitidine, which can also help reduce skin symptoms.
Aspirin or other non-steroidal anti-inflammatory drugs, if tolerated by the patient, provide relief from flushing and lightheadedness by blocking the body's production of prostaglandin D2. These drugs can cause unexpected severe reactions, though, and their use must be instituted cautiously under careful medical supervision.
Cromolyn (disodium cromoglycate) is a mast cell stabilizing drug which is frequently effective in reducing skin and gastrointestinal symptoms as well as mental and other systemic systems.
For severe diarrhea or malabsorption, collection of fluid in the abdominal cavity, and continued anaphylaxis which fails to respond to other measures, systemic corticosteroids may be required.
People with mastocytosis should carry injectable epinephrine, and they should know how to inject themselves if necessary to treat anaphylaxis.
There are other medications which may provide symptomatic relief if the ones mentioned above are ineffective or undesirable for a particular patient. No new medication or remedy should be started without careful consideration and close supervision, in case of an unexpected reaction.
Prognosis
It is not yet possible to predict the course of mastocytosis in any individual person. When involvement is limited to the skin, symptoms may improve or clear entirely, but it is also possible for the disease to progress to the systemic form. In about half the young children affected, symptoms disappear as they reach adulthood.
When the mast cell infiltration is systemic, symptoms may progress slowly over many years or may suddenly increase temporarily or permanently. The patient may even progress to the more serious categories of disease.
For the small percentage of patients who develop an associated hematological disorder, the course varies, and the prognosis depends on the associated hematological disease. ( 2 )
It is very important for the patient and the doctor to maintain good communication and to work cooperatively to achieve the best possible symptom control. Communication with other doctors caring for mastocytosis patients, and with other persons who have the disease, is important in order to maintain a support and information network. The affected person, or the child's parents, should strive to become educated about mastocytosis and to be aware of their individual needs and responses to triggering factors. A recognized medical warning device, such as a MedicAlert bracelet, should be worn, and extra caution is needed when undergoing dental work or surgery.
The Mastocytosis Society provides education and support to people with all forms of mast cell disease and their doctors, encourages research, and hopes to help find a cure for the disease. The Society also maintains a list of consultants who are available to advise professionals caring for a mastocytosis patient. Because of the rare nature of mast cell disease, we encourage doctors and patients to register with the Society in order to facilitate the communication and information exchange which will hasten the achievement of a cure.
Classification (adapted from (1) )
The following is a useful classification of the kinds of mastocytosis.
Cutaneous mastocytosis: Skin involvement only. This may include:
Urticaria pigmentosa: The typical rash of mastocytosis in the skin.
Solitary mastocytoma - a clump of mast cells restricted to a small area of the skin.
Diffuse cutaneous mastocytosis - skin involvement without urticaria pigmentosa or telangiectasia macularis eruptiva perstans (distinctive patches of discolored skin with small blood vessels on a reddened background. If the skin is heavily infiltrated with mast cells, the release of large amounts of mast cell products may cause systemic symptoms.
Systemic mastocytosis with or without skin involvement: Mast cell infiltration of at least one internal organ (like bone marrow or gastrointestinal tract). (2)
Mastocytosis in association with hematological disorder, with or without skin involvement: For example: leukemia, lymphoma, and myelodysplastic or myeloproliferative disorders.
Lymphadenopathic mastocytosis with eosinophilia, with or without skin involvement: Enlarged spleen and lymph nodes, infiltrated with mast cells, along with a blood count high in eosinophils.
Mast cell leukemia: This is rare but is the most serious form of masocytosis. The treatment and course of the disease is dictated by the leukemia.
Table of mast cell degranulators (adapted from (3) )
Allergens and other immunologic stimuli
Exercise
Physical stimuli (heat, cold, sunlight, friction, pressure, vibration)
Bacterial toxins
Venoms (snake and insect, especially bee and wasp stings)
Biologic polypeptides (released by intestinal roundworms, jellyfish,crayfish, and lobster)
Polymers (Compound 48/80, dextran)
Drugs: Aspirin, alcohol, narcotics (codeine, morphine), polymyxin B,amphotericin B, D-tubocurarine, quinine, iodine-containing radiographic dyes, scopolamine, gallamine,decamethonium, reserpine.
References:
1. Dean D. Metcalfe. Classification and Diagnosis of Mastocytosis:Current Status. J Invest Dermatol 96: 2S-4S, 1991.
2. Linda Golkar, Jeffrey D Bernhard. Seminar: Mastocytosis. Lancet 1997; 349:1379-85
3. Jack Longley, Thomas P. Duffy, Steven Kohn. Continuing Medical Education: The mast cell and mast cell disease. J Am Acad Dermatol 1995;32:545-61
Last update 6th December,2004
12 comments:
My sister has this. I'm doing research and have bookmarked your blog. I plan on coming back as I want to read your entire blog.
Hello there,
My boyfriend from New Jersey has been told this is what he has. He had a bone marrow biopsy and received the results that he has 10% mass cells. He is 21.
I have been reading your blog as a way to prepare myself. I did direct him too read it as well, but he feels that he doesn't want to read about things that will happen too him, if they are not currently happening.
I wish you all the best and will be continuing following you.
I'd never heard of Systemic Mastocytosis until a couple of weeks ago, and I just now found your blog. Last Thursday I was diagnosed with Systemic Mastocytosis. Currently I feel fine, but know I have much to learn and try to understand, both for myself and my husband, and also so that I can tell our grown daughters about my diagnosis. I've bookmarked your site and will return. Thank you and may God bless You, Kevin!
Hi,
I live in Leeds, England & was diagnosed with SM a few years ago, although i've suffered with this for 13 years. I feel EXACTLY as you describe, Kevin & Mark. It is a scary experience & doesn't get any easier. I'm trying dasatinib at the moment, but still had a bad attack last week. I was at work & they had to call an ambulance. It is sooooo annoying.
I do try to be positive though & have a great family who support me.
take care everyone
I love the picture of you and your wife! I check in on you once in a while. I am glad you are feeling better. Keep keeping on!
Hello Kevin,
I have been living with systemic mastocytosis since 2006. I had a "shock" episode and my doctor thought I had a carcinoid tumor but latter tested for SM and confirmed it with a bone marrow biopsy. I live in a small town and was fortunate to be going to the only Dr. in town that knows what Mastocytosis is.
I read your blog for the first time today. In one of your posts you mentioned eating pizza and waking with an attack. I cannot eat anything made with tomato sauce or paste. Fresh tomato I can eat but when it is condensed it's a trigger everytime.
I'm glad I found your post and will be back.
Barbara
I too have SM, diagnosed in 2009. I'm blessed in that I haven't had the reactions I have read with regard to SM. I saw a specialist last month and he put my anxiety to rest, at least for right now. haha I experienced anaphylaxsis in Dec 2010 (most likely due to antibiotic) so I feel your pain!! I'm still learning, carrying my epi pens and glad to find your posts as well so I'm not alone. I pray we find a cure and that you have a great year of good health!! Take care!
My name is Brandi, my husband, Mick, 44 years old, was diagnosed with Mastocytosis on Monday, 5/16/11. We are obviously in the very preliminary stages & don't know a whole lot yet. Kevin, I really appreciate this blog & your story being posted! We have received the tryptase results, being 22. We live just south of Kansas City & unfortunately there are not any doctors in our area that know much about this condition. We have scheduled appointments with the Cleveland Clinc for June 6th & the Mayo Clinic in Rochester June 30th. He is in a tremendous amount of discomfort & would greatly appreciate any advice on what we can do from home to ease his discomfort, if anything. He is currently taking over the counter benadryl, which sometimes seems to help, but not all the time. Last night & this morning he had pretty severe attacks, involving coughing, air in the abdominal cavity, vomiting, and tightness in the chest & neck, both attacks have lasted 30+ minutes. We are very anxious to get to a doctor that can help, but hate that it's not any sooner than it is. It is nice finally getting to the bottom of this whole deal! We have been trying to figure this out for a couple of months now, & everything is finally starting to make sense. For years, he has jokingly said that he is allergic to alcohol, because everytime he drinks a beer, just one, his face would turn red & he would get these red blotchy spots, which would go away after a few minutes. Now we have learned that alochol can be a trigger, along with spicy food, which he loves... Any advice or recommendations would be greatly appreciated! Thanks again to Kevin & all his followers for keeping this blog alive! Take care! Sincerely, Brandi
That is very good news that the body and mind is coping well to the medication and responding well.It is a hard journey...god that everything is working out the right way for you.
God bless you and all who are affected by this terrible disorder.
I do online research regarding nutritional issues, and noticed that "malabsorption" was mentioned in a short article explaining mastocytosis. While I don't necessarily think that nutritional deficiencies cause the problem, if the disorder causes malabsorption (gut cannot absorb nutrients > leaky gut syndrome > inflammation > auto-immune disorders) whatever causes leaky gut (gluten problems and/or other food allergies) could contribute to the mast cell problem and also worsen the malabsorption, which then reinforce each other, ad infinitum. Consider also the state of nutrition in the US and the world; boxed foods made with grains stripped of all nutrients; the human metabolism requires X nutrients in Y amounts everyday at each meal in order to keep each of us alive and well. We are biochemical machines, but our biochemistry does not function without its require fuels; minerals moderated and catalyzed by vitamins, enzymes, amino acids, all made from foods by our bodies. Without nutrients, our biochemistry cannot function.
Without knowledge of nutrient deficiencies, the deficiencies cannot be solved. Please consider finding the type of doctor who can order the type of blood test that reveals what vitamins and mineral supplementation might be required in order to enable the body to repair its tissues and for its biochemical reactions to proceed.
I'm not just whistling in the cark, but am recovering from insulin resistance -- not dangerous in the emergency way of mastocytosis, but getting competent help regarding nutritional deficiencies gave me health for the first time in my life. Knowledge is power; empower yourselves -- it can't hurt and it might help. http://www.doctoryourself.com/
http://www.orthomolecular.org/
Hi Brandi,
I hope Mick gets some relief at the Cleveland Clinic on Tuesday. If not, please let us know. Watch carefully that he does not pass out and inhale vomit. That can kill him.
Is there someplace where those who want can go for a discussion? I'd like to talk and answer each others questions.
I'm on Facebook, but I don't know how to find others living with mastocytosis there.
Hi Keven, may I ask what were your first symptoms at 30 years old?
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