Suggest Medical Tests To Rule Out Mastocytosis

Posted on Fri, 18 Mar 2016

Question: I am extremely sensitized to environmental toxicants like mold and chemicals, but recently after having been eating different fermented foods daily for the last month or so, these sensitivities have been exacerbated to the point I have shallow breathing and my body feels like it is always on the verge of going into shock. I have been doing a lot of outdoor living (due to sensitivities to indoor toxicants) and have hence been exposed to colder temperatures. Since both fermented foods and extreme temperatures can result in symptoms like this with mast cell disorders such as mastocytosis or mast cell activation disorder, how do I test for such conditions?

Answered by Dr. Noble Zachariah (43 minutes later)

Brief Answer:
Discussion follows

Detailed Answer:
Hello,
Welcome and thanks for your query.
I understand your concern.
If you have mastocytosis, you are likely to have low WBC count in the blood. You can test the Tryptase level in the blood and value above 20 nanogram per ml is suggestive of mastocytosis. 24 hour urinary excretion of histamine or Prostaglandin D2 may be done if available. Other helpful investigation would be finding of enlargement of spleen and neck lymph nodes by ultrasound examination.
A bone marrow examination is the diagnostic test.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (3 hours later)

Thank you very kindly Dr. Zachariah! Two clarification questions:

I. Do you know if these tests can be performed in urgent care or ER settings in America?

II. If I present with anaphylactic shock symptoms from such possible complications, what can I do en rote to ER (antihistamine?) and what would they do at ER (epinephrine injection?).

Answered by Dr. Noble Zachariah (1 hour later)

Brief Answer:
Please see the following

Detailed Answer:
Welcome back.
These are special tests which may not be present in the ER.
If you suspect an anaphylactic reaction, you should go to the ER without delay. You may take antihistamine or steroids on the way but the most effective treatment is epinephrine which would be administered in the ER preferably under monitoring.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (4 hours later)

Thank you very kindly for helping me with this information and your guidance Dr. XXXXXXX I am very grateful.

Would my general care practitioner (I have an internal medicine specialist) be able to conduct such tests, or would I have to see an immunologist?

I don't believe I have exhibited anaphylactic symptoms with this to date, but my body keeps getting increasingly overwhelmed by these triggers to the point I feel I almost go into shock, and my body is having an increasingly difficult time sleeping and relaxing. Would you believe there would be any indirect diagnostic tests in an urgent care or ER setting which might shed light on possible mastocytosis or mast cell mis-functioning - for example, markers of recent shock or excess histamine?

Answered by Dr. Noble Zachariah (5 hours later)

Brief Answer:
You are welcome.

Detailed Answer:
It was a pleasure interacting with you.
In my country of work an internist can order these tests . Please check with your internist whether it is possible to have the tests done. If not you may be referred to the immunologist.
However there is no occlusive test which can be done in the ER for mastocytosis.
Do get back to me if you have any further queries.
Wish you good health and a great day.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar