Recommendations for Improving the Diagnostic Criteria for Mast Cell Activation Syndrome

Abstract

Mast Cell Activation Syndrome (MCAS) is a disorder in which patients experience a wide variety of frequently debilitating allergic reactions and symptoms. The onset can be sudden, and it is often a life-changing disorder that brings about an enormous amount of suffering and disability. Patients can react to a wide variety of triggers and experience any combination of numerous symptoms that affect various organs, and while a few treatments do exist, patient access to these treatments requires a diagnosis, which is often very difficult to obtain due to several factors to be discussed. At the time of this writing, a thorough review of the literature illustrates that little research has been done on this disorder, and the diagnostic criteria remains controversial. There have been five major diagnostic criteria proposed since 2012, and several subsequent revisions; yet, all are criticized for their absence of supporting studies and citations, the authors’ lack of experience with treating MCAS patients, and their heavy reliance on the use of tryptase as a diagnostic biomarker (Afrin et al., 2020; Afrin et al., 2017). Additionally, significant issues exist with obtaining evidence of an increase in any of the currently tested mediators due to several reasons, such as the narrow window of time in which they can be detected, as well as their strict refrigeration requirements. This often results in false negatives, and leads not only to retesting, which is very expensive, but to a diagnostic delay that causes the patient more suffering by preventing access to treatments. Therefore, to potentially solve these dilemmas, it seems logical to address the need to revise and refine the current diagnostic criteria for MCAS.