Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to ...Treatment: A Case Series, 2023, Weinstock et al

https://www.mdpi.com/2075-4426/13/11/1562

Abstract
Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%. Mast cell chemical mediators lead to heterogeneous multisystemic inflammatory and allergic manifestations. This syndrome is associated with various neurologic and psychiatric disorders, including headache, dysautonomia, depression, generalized anxiety disorder, and many others. Although MCAS is common, it is rarely recognized, and thus, patients can suffer for decades. The syndrome is caused by aberrant mast cell reactivity due to the mutation of the controller gene.

A case series is presented herein including eight patients with significant neuropsychiatric disorders that were often refractory to standard medical therapeutics. Five patients had depression, five had generalized anxiety disorder, and four had panic disorder. Other psychiatric disorders included attention-deficit hyperactivity disorder, obsessive compulsive disorder, phobias, and bipolar disorder. All eight patients were subsequently diagnosed with mast cell activation syndrome; six had comorbid autonomic disorders, the most common being postural orthostatic tachycardia syndrome; and four had hypermobile Ehlers-Danlos syndrome.

All patients experienced significant improvements regarding neuropsychiatric and multisystemic symptoms after mast-cell-directed therapy. In neuropsychiatric patients who have systemic symptoms and syndromes, it is important to consider the presence of an underlying or comorbid MCAS.

 

The article gives a huge list of symptoms for MCAS, and a prevalence of 17%. I assume this means they are calling all common allergies and sensitivities 'MCAS'.
I looked at the treatment section, which starts with drugs such as antihistamines and goes on to include some less commonly used drugs. This is the beginning of the treatment section:

The limitations section of the article pretty much wipes out any conclusions that can be drawn from this case series, so I don't think any definite conclusions can be drawn: