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Doctor suggested Mastocytosis. Anyone?

Discussion in 'Mast Cell Disorders/Mastocytosis' started by MNC, Jul 14, 2010.

  1. MNC

    MNC Senior Member

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    Hi. I went to a neurologist who is very reputated and runs a sleep disorders clinic. I showed my old sleep study and he was very interested. He started to find many abnormalities that they hadn't noticed at the public hospital where I took the sleep study.

    Anyway, the guy got like very interested and started asking lots of questions about my whole condition. He didn't know much about CFS but still said, let's see, you never know, you have terrible symptoms and signs and tests showing many things wrong.

    Anyway... he got to a point where he said that I might have MASTOCYTOSIS. He told me to go to some skin & mastocytosis specialist first and then we'd see step by step.

    So, I came home and googled for Mastocytosis. And in fact it the symptoms match too in many ways, sounds like CFS and the hypersensitivity I have to everything which is not full MCS, mostly my untreatable respiratory tract mess and so on.

    You can see here: http://en.wikipedia.org/wiki/Mastocytosis

    So I came here and searched in the forum and I saw that it has been discussed before, but not specifically about Mastocytosis but as Histamine Intolerance: http://www.forums.aboutmecfs.org/showthread.php?1804-Histamine-intolerance-anyone-got-that

    So, given that apparently having Mast Cell disease is also (as usual) common in CFS, and given that the tests for Mastocytosis are terrible (biopsies), I'd like to ask if someone has gone this route before and got tested and so on.

    I would appreciate any input.

    Thanks in advance.
  2. taniaaust1

    taniaaust1 Senior Member

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    Hi.. I have an uncle with systemic Mastocytosis.. its very very rare. (1 in every 150,000?) . There has been a few families in which in has run in family (so obviously some kind of genetic link)

    Its a truely terrible thing to have as it can often be fatal, (my uncle goes into anaphaltic shock and needs resusitation a lot)... Interestingly, his daughter (my cousin) has been on disablity since a teen due to having the same symptoms as me. Her doctors dont believe in CFS.. so her illness is unknown, she thinks she has what her father has (all her tests are negative) but i think she has what i have ME (canadian consensus CFS). My uncle kept thinking i had Mastocytosis too and probably still does.

    Cause of my family history, Ive been tested for Systemic Mastocytosis and the test which was done on me the immunologist told me it was a new blood test and reliable (i thou dont know whether to believe that or not). My uncle used to tell me the blood test often didnt show it up and that a biopsies were needed... and that if the right place wasnt biopsied in the right organ its in or in the right area of the bone marrow, it can be missed (it can be anywhere in the body, all different organs but usually somewhere in the bone marrow). (My uncle used to spend all his time online reseaching this illness.. as he's cut off from the rest of the world due to it, due to the severe life threatening allergies it gives him). Just someone having peppermint breath about him almost killed him!!.

    I personally wouldnt be suprised if one day I did develolp that .. as i have had dermatographism (which is excess mast cells in the skin) .. and also twice over the years developed a rash on my arm interestingly in same place, which blistered on touch (doctor put that down to some kind of viral rash). I really wish I'd know about Systemic mastocytosis then and got that biopsied (as if one gets a Mastocycotisis rash.. they can be biopsied for it.. but rashes dont always appear in systemic mastocytosis).

    From what i know about this illness, it is very unlikely you have it .. have you got Mastocytosis rash?? as well as the other symptoms you have?? (one can say more likely that you could have it if you have the rash). The specialist if he didnt know much about CFS (canadian consensus defination) .. could easily think instead you could have mastocytosis (seeing the symptoms are VERY ALIKE). Mastocytosis is an very undiagnosed illness as most doctors have never even heard of it and most would never have had a Mastocytosis esp Systemic kind of patient. So im sure there are ones with CFS out there who actually do have this serious disease.
    ..............

    Anyone here.. if you do have a strange rash of spots or a strange patch on your body.. please reseach Mastocytosis. Matocytosis causes serious allergy reactions.
  3. helsbells

    helsbells Senior Member

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    Hi I actually asked my specialist if he thought I could have this but he siad not - I think on the grounds that didn't know much about it and that he thinks the autonomic problems account for everything being dysregulated. Do you have particularly bad skin rashed/manifestations? I know I react to my own histamine and make it in response to most things. But i am sorry I cannot help you further.
  4. helsbells

    helsbells Senior Member

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    Thank -you for this post I found it really helpful - I just learned more from you than my hospital specialist. Are the spots a particular type? Are reactions always anaphaltic? This must be awful for your uncle - I have severe mcs and can get severe reactions from very small exposures but this something else :( I understand how isolating things are for me so it must be very hard for him as the consequences are so extreme. Thank you again that was a really great post.
  5. taniaaust1

    taniaaust1 Senior Member

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    Common CFS/ME sleep study abnormalities are.. shorted time in deeper stages of sleep .. also alpha wave intrusin into delta waves within non-REM sleep (from the canadian consensus doc).
    Enid likes this.
  6. taniaaust1

    taniaaust1 Senior Member

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    No not always anaphalatic, it depends on how bad the attack was and some may not be as extreme to go into anaphalatic shock.. last time i saw him he was shaky, weak, exhausted and at times having trouble breathing (and probably had other symptoms which couldnt be seen due to the illness. Another reason why a CFS and mastocytosis may be confused is cause all kinds of things can trigger off an mastocytosis attack INCLUDING EXERCISE (it depends on the individual). Mastocytosis suffers also suffer from exhaustion due to their body attacking itself. (my uncles case is ongoing.. i dont think he's truely ever well, his mast cells are always at a high level even with meds.
    .......

    here i just found something online which is better explaination to what ive tried to give on adult Mastocytosis
  7. taniaaust1

    taniaaust1 Senior Member

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    Im feeling quite good tonight so I thought i'd look for some pictures of this disorder to put up here, it can look quite different in different cases... but any rash when tested which gets what they call "darier sign" by stroking is suspect of this disorder (thou not all with darier sign have this)

    "Table 11.7 SYMPTOMS AND ORGAN-SPECIFIC FEATURES THAT MAY OCCUR IN MASTOCYTOSIS

    Organ system Symptom or feature Comments

    Skin Itch (mediated by prostaglandin D2),wheals (leukotrienes), flushing (chymase), blisters (histamine) Wheals in localized disease (mastocytoma, limited urticaria pigmentosa) are at the site of lesions, but they may occur elsewhere in more extensive disease.Blisters are most commonly a feature of extensive mastocytosis in infants and young children, improving with time.

    General General malaise or tiredness, fever Constitutional symptoms suggest signi´Čücant systemic involvement.

    Cardiac Palpitations, dizziness, fainting, chest pain Different mediators involved in the different symptoms.

    Respiratory Dyspnea Uncommon.

    Gastrointestinal and abdominal Nausea or vomiting, diarrhea, cramps, dyspepsia; splenomegaly, hepatomegaly Epigastric pain suggests peptic ulcer and systemic disease. Splenomegaly probably occurs in about 50% with systemic disease.
    Bone and bone marrow Osteoporosis, bone pain Focal radiolucent or radiopaque bone lesions are fairly common. Subclinical bone marrow involvement (increased bone marrow mast cells) occurs in most adults with mastocytosis but is rare in children. Bone pain may occur in systemic disease.

    Neurologic Headache Cognitive impairment may occur in systemic disease."
    http://www.merckmedicus.com/ppdocs/us/hcp/content/white/chapters/white-ch-011-s005.htm

    http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=-641759496
    http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=-1471757501
    http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=-488658615
    http://www.dermis.net/dermisroot/en/41753/imagep.htm
    http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-1332030879
    http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=1082341170
    http://emedicine.medscape.com/article/1096183-overview (has some pictures too if one scrolls down).
    ........

    Note.. not everyone with systemic mastocytosis gets lesions (as far as i know my uncle dont get the lesions/rash).. but one may have one lesion or heaps.
  8. Karin

    Karin

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    My son has a mastocytoma on his leg. It toold like a small flat pale mole, but it you scratch it a bit with your nail it grows into a massive welt, one inch diameter with a raised white dome in the center. After a couple hours it is back down to barely noticeable.

    Concerning mastocytosis, it is also suspected to play a role in autism. Below is a link to a video you MUST WATCH if you are interested in neurological consequences of mastocytosis.

    Mast cells disrupt the gut-blood-brain barriers and contribute to autism by Theoharis Theoharides, MD, PhD
    http://ec2-174-129-232-51.compute-1...-contribute-autism-theoharis-theoharides-md-p

    One option, if mastocytosis is suspected, would be to try mast cell blockers. The video above explains which substances act this way. For example, Quercetin, Ruteolin, and some medications not available in the US like Ketotifen (available from Canada through some compounding pharmacies).

    The problem with antihistamine drugs available in the US is that they do just that: block histamines. Mast cells release a ton of different substances, not just histamines, and some of these other substances are more damaging neurologically. This is not widely known by mainstream doctors. Also, as explained in the video above, mast cell activity might also contribute to leaky BBB and leaky gut.

    So there is potential for a lot of issues with mastocytosis.
    camas likes this.
  9. muffin

    muffin Senior Member

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    Wow!!! This does sound like CFIDS in many ways. Thanks for posting

    -->>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. Now, how does Connective Tissue disorders (common to CFIDS and FM) and POTS (common to Connective Tissue Disorders) play into this? Very interesting. Now I wonder if this is part of CFIDS for a sub-group. Also wonder if this really is an "orphan disease". Interesting. Wish my brain worked...

    ================================================================
    Mastocytosis
    From Wikipedia, the free encyclopediaJump to: navigation, search
    Mastocytosis

    Mastocytosis is a group of rare disorders of both children and adults caused by the presence of too many mast cells (mastocytes) and CD34+ mast cell precursors in a person's body.[1]

    [edit] Pathophysiology
    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 that we may not be able to survive with too few mast cells.

    Mast cells express a cell surface receptor termed c-kit[2] (CD117), which is the receptor for scf (stem cell factor). In laboratory studies, scf appears to be important for the proliferation of mast cells. Mutations of the c-kit receptor leading to uncontrolled stimulation of the receptor is a cause for the disease. Inhibiting the tyrosine kinase receptor with imatinib (see below) may reduce the symptoms of mastocytosis.

    [edit] Classification
    Mastocytosis can occur in a variety of forms.

    Most cases are cutaneous (confined to the skin only). There are several forms of cutaneous mastocytosis. The most common is called urticaria pigmentosa (UP). It is most common in children. Telangiectasia Macularis Eruptiva Perstans (TMEP) is a much rarer form of cutaneous mastocytosis that affects adults.[3]
    Systemic mastocytosis involves the internal organs, usually in addition to involving the skin. Mast cells collect in various tissues and can affect organs such as the liver, spleen, lymph nodes, and bone marrow.
    Other types of mast cell disease include:
    Mast cell leukemia
    Mast cell sarcoma
    [edit] History
    Scientists first described urticaria pigmentosa in 1869.[4] Systemic mastocytosis was first reported by scientists in 1936.[5]

    [edit] Symptoms
    When too many mast cells exist in a person's body and undergo degranulation, the additional chemicals can cause a number of symptoms which can vary over time and can range in intensity from mild to severe. Because mast cells play a role in allergic reactions, the symptoms of mastocytosis often are similar to the symptoms of an allergic reaction. They may include, but are not limited to:[6]

    Fatigue
    Skin lesions (urticaria pigmentosa) and Itching
    Abdominal discomfort
    Nausea and vomiting
    Diarrhea
    Food and drug intolerance
    Olfactive intolerance
    Infections (bronchitis, rhinitis, and conjunctivitis)
    Ear/nose/throat inflammation
    Anaphylaxis (shock from allergic or immune causes)
    Episodes of very low blood pressure (including shock) and faintness
    Bone or muscle pain
    Decreased bone density
    headache
    Ocular discomfort
    Malabsorption
    [edit] Diagnosis
    Doctors can diagnose urticaria pigmentosa (cutaneous mastocytosis, see above) by seeing the characteristic lesions that are dark-brown and fixed. A small skin sample (biopsy) may help confirm the diagnosis.

    By taking a biopsy from a different organ, such as the bone marrow, the doctor can diagnose systemic mastocytosis. Using special techniques on a bone marrow sample, the doctor looks for an increase in mast cells. Another sign of this disorder is high levels of certain mast-cell chemicals and proteins in a person's blood and sometimes in the urine.


    [edit] Epidemiology
    No one is sure how many people have either type of mastocytosis, but mastocytosis generally has been considered to be an "orphan disease" (orphan diseases affect 200,000 or fewer people in the United States). Mastocytosis, however, often may be misdiagnosed, especially because it typically occurs secondary to another condition, and thus may occur more frequently than assumed.

    [edit] Treatment
    There is currently no cure for mastocytosis. However, there are a number of medicines to help treat the symptoms of mastocytosis:

    Antihistamines block receptors targeted by histamine released from mast cells. Both H1 and H2 blockers may be helpful.
    Leukotriene antagonists block receptors targeted by leukotrienes released from mast cells.
    Mast cell stabilizers help prevent mast cells from releasing their chemical contents. Cromolyn Sodium Oral Solution (Gastrocrom / Cromoglicate) is the only medicine specifically approved by the U.S. FDA for the treatment of mastocytosis. Ketotifen is available in Canada and Europe, but is only available in the U.S. as eye drops (Zaditor).
    Proton pump inhibitors help reduce production of gastric acid, which is often increased in patients with mastocytosis. Excess gastric acid can harm the stomach, esophagus, and small intestine.
    Epinephrine constricts blood vessels and opens airways to maintain adequate circulation and ventilation when excessive mast cell degranulation has caused anaphylaxis.
    Albuterol and other beta-2 agonists open airways that can constrict in the presence of histamine.
    Corticosteroids can be used topically, inhaled, or systemically to reduce inflammation associated with mastocytosis.
    Antidepressants are an important and often overlooked tool in the treatment of mastocytosis. The stress and physical discomfort of any chronic disease may increase the likelihood of a patient developing depression. Depression and other neurological symptoms have been noted in mastocytosis.[7] Some antidepressants such as doxepin are themselves potent antihistamines and can help relieve physical as well as cognitive symptoms.
    Dihydropyridines are calcium channel blockers that are sometimes used to treat high blood pressure. At least one clinical study suggested that Nifedipine, one of the dihydropyridines, may reduce mast cell degranulation in patients that exhibit urticaria pigmentosa. A 1984 study by Fairly et al. included a patient with symptomatic urticaria pigmentosa who responded to nifedipine at dose of 10 mg po tid.[8] However, Nifetipine has never been approved by the FDA for treatment of mastocytosis.
    In rare cases in which mastocytosis is cancerous or associated with a blood disorder, the patient may have to use steroids and/or chemotherapy. The novel agent imatinib (Glivec or Gleevec) has been found to be effective in certain types of mastocytosis.[9]

    There are clinical trials currently underway testing stem cell transplants as a form of treatment.

    There are support groups for persons suffering from mastocytosis. Involvement can be emotionally therapeutic for some patients.

    [edit] Research
    National Institute of Allergy and Infectious Diseases (NIAID) scientists have been studying and treating patients with mastocytosis for several years at the National Institutes of Health (NIH) Clinical Center.

    Some of the most important research advances for this rare disorder include improved diagnosis of mast cell disease and identification of growth factors and genetic mechanisms responsible for increased mast cell production. Researchers are currently evaluating approaches to improve ways to treat mastocytosis.

    Scientists also are focusing on identifying disease-associated mutations (changes in genes). NIH scientists have identified some mutations, which may help researchers understand the causes of mastocytosis, improve diagnosis, and develop better treatments.

    [edit] See also
    Mast cell tumors are found in many species of animals.
    [edit] References
    1.^ Horny HP, Sotlar K, Valent P (2007). "Mastocytosis: state of the art". Pathobiology 74 (2): 12132. doi:10.1159/000101711. PMID 17587883.
    2.^ Orfao A, Garcia-Montero AC, Sanchez L, Escribano L (2007). "Recent advances in the understanding of mastocytosis: the role of KIT mutations". Br. J. Haematol. 138 (1): 1230. doi:10.1111/j.1365-2141.2007.06619.x. PMID 17555444.
    3.^ Ellis DL (1996). "Treatment of telangiectasia macularis eruptiva perstans with the 585-nm flashlamp-pumped dye laser". Dermatol Surg 22 (1): 337. doi:10.1016/1076-0512(95)00388-6. PMID 8556255.
    4.^ Nettleship E, Tay W (1869). "Rare forms of urticaria". Br Med J (2): 3234.
    5.^ Szary A, Levy-Coblentz G, Chauvillon P (1936). "Dermographisme et mastocytose". Bull Soc Fr Dermatol Syphilol 43: 35961.
    6.^ Hermine O, Lortholary O, Leventhal PS, et al. (2008). "Case-control cohort study of patients' perceptions of disability in mastocytosis". PLoS ONE 3 (5): e2266. doi:10.1371/journal.pone.0002266. PMID 18509466.
    7.^ Rogers MP, Bloomingdale K, Murawski BJ, Soter NA, Reich P, Austen KF (1986). "Mixed organic brain syndrome as a manifestation of systemic mastocytosis". Psychosom Med 48 (6): 43747. PMID 3749421. http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=3749421.
    8.^ Fairley JA, Pentland AP, Voorhees JJ (1984). "Urticaria pigmentosa responsive to nifedipine". J. Am. Acad. Dermatol. 11 (4 Pt 2): 7403. doi:10.1016/S0190-9622(84)70233-7. PMID 6491000.
    9.^ Droogendijk HJ, Kluin-Nelemans HJ, van Doormaal JJ, Oranje AP, van de Loosdrecht AA, van Daele PL (2006). "Imatinib mesylate in the treatment of systemic mastocytosis: a phase II trial". Cancer 107 (2): 34551. doi:10.1002/cncr.21996. PMID 16779792.
    Based on an informative page by the National Institute of Allergy and Infectious Diseases (NIAID).
    [edit] External links
    Mastocytosis Society, Inc.
    Mastokids.org
    UK Mastocytosis Support
    Enid likes this.
  10. MNC

    MNC Senior Member

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    Thanks a lot for your replies and all the wonderful information. Let's see what the specialist says on the 26th of July when I must see him. Some things make sense to me and others not so much. As usual.

    Thanks a lot again.
  11. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    Not sure if you are looking for a Dr, but I saw this someplace recently: http://www.nih.gov/about/researchresultsforthepublic/RareDiseasesCRN.pdf
  12. leaves

    leaves Senior Member

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    Hi
    Any news from your doc?
    Klimas put me on gastrocrom for my allergies and gi inflammation, which is also a med for mastocystosis, that's why I ask
  13. xrayspex

    xrayspex Senior Member

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    leaves--why were u put on gastrocrom and how did it work out?
  14. xrayspex

    xrayspex Senior Member

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    u.s.a.
    and mnc whatever happened for u and that neurologist and the mastocytosis?
  15. taniaaust1

    taniaaust1 Senior Member

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    Since this orignial thread was started quite a time ago now... I did find out some new things ... there was a study done on one of the types of POTS.. I think it was the hyperadrenaline kind (forgot exactly what its called).. and they found on testing in this study, that the study partipates who had POTS and that.. actually all also had a mast cell disorder going on.
    ...

    Here's a bit more on POTS and mast cell issues.

    "Mast-cell activation disorders may play a role in the development of POTS in some individuals. Some patients with orthostatic intolerance suffer from episodes of flushing, palpitations, shortness of breath, chest discomfort, headache, lightheadedness, hypotension or hypertension and occasionally syncope (Jacob & Biaggioni, 1999). Exercise may trigger an attack (Shibao, Arzubiaga, Roberts, Raj, Black, Harris & Biaggioni, 2005). Patients may complain of increased fatigue, sleepiness, increased urination and/or diarrhea after an attack (Jacob & Biaggioni, 1999). Symptoms of orthostatic intolerance often worsen after an episode. An increase in urinary methylhistamine, a marker of mast-cell activation, can be found in these patients.

    Mast-cell activation results in the release of the vasodilator histamine, which may contribute to symptoms of POTS. Other mast cell mediators, such as plasma prostaglandin 2, may contribute to symptoms as well. Urinary histamine is often measured in the evaluation of flushing, but it is less specific than methylhistamine and not useful in the diagnosis of mast-cell activation (Shibao et al., 2005). Patients should be instructed to collect urine for a 4-hour period immediately after a severe spontaneous flushing episode. Urinary methylhistamine is usually normal between episodes in patients with mast-cell activation disorders, although the patients may experience chronic fatigue and orthostatic intolerance between episodes, which can lead to a disabling condition (Shibao et al., 2005).

    Beta blockers should be used with caution, if at all, in those with mast-cell activation disorders (Shibao et al., 2005). Beta blockers may trigger mast-cell activation. "

    the above came from http://www.dinet.org/what_causes_pots.htm
  16. Enid

    Enid Senior Member

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    Thanks alot for this very interesting and informative thread (always wondered apart from everything else what my Osteoporosis had to do with things). Tania @5 re sleep - exactly what is happening. Mast cell disorders certainly seem to explain so much.
  17. floydguy

    floydguy Senior Member

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    This Dr. Theoharis Theoharides' work. He has been at a number of high profile ME events. Here is a link in the context of autism research and mast cells:

    http://www.autismmedia.org/media3.html

    I will soon be taking his concoction Neuroprotek which is supposed to help settle the Mast Cells.

    http://www.algonot.com/neuroprotek.php

    A friend was recently dx'd with Mastocytosis. Previously she had been dx'd with MS. Apparently one of the best MDs for this is a Dr. Cassellas (sp?) out of Brigham & Womens in Boston. There are a lot of similarities including POTS. My friend has POTS pretty badly.
    xrayspex likes this.
  18. Marco

    Marco Old blackguard

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    Thanks from me also for starting this thread.

    I've never heard of Mastocytosis before but after reading a number of documents and patient blogs my symptom profile actually fits this diagnosis as well as or better than ME/CFS. Unfortunately the possibility of a correct diagnosis of Mastocytosis looks to be even more problematic than for those lumped together under the CFS label.

    This is a long but well worth reading paper prepared by the Mastocytosis Society Canada with the apparent intention of educating the medical profession on this group of diseases, misdiagnosis and issues such as gender bias and includes individuals' stories of long searches for a diagnosis which are all too familiar.

    One patient who had previously undergone a hysterectomy was told her symptoms were due to "mourning for your uterus" which would be hilarious if not for the fact that mastocytosis can be fatal in certain circumstances.

    https://docs.google.com/viewer?a=v&...tkYKUn&sig=AHIEtbQcgKBq4uy8U04Vus1SUnVsODS2nA

    Mastocytosis is described as very rare but given the widespread ignorance of the disease and the difficulties in diagnosis I'd be surprised if the actual incidence isn't much higher.
  19. Enid

    Enid Senior Member

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    Can't believe there are still in 2012 Docs around who can say "mourning for your uterus" - preserve me from Docs is all I can say. No wonder we all ran away here when they were faced with ME.
    ahimsa and xrayspex like this.
  20. xrayspex

    xrayspex Senior Member

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    I am very intrigued by my "discovery" of mastyocytosis as a possibility. It could really account for a lot, my extreme sensitivities and headaches food senstivities unpredictability of it all, sometimes breatheing issues or dysphagia, but its all been sublicinical, very frustrating. It ties in to CFS sx a lot. even the PEM.

    I am a bit reluctant to ask doc for test to confirm it, i think histamine serum level and tryptase are a couple non-invasive ones, but in case they were negative he would think it was more neurotic worrying or might think its conclusive when I dont think it necessarily would be from what I read.

    I don't quite understand what the difference is between allergies, asthma, autoimmune issues and other stuff and masto, because I would think overlap. oh also have ostepenia. I do get different skin issues but doesnt seem like classic masto dertmatitis pix, not brown.
    Has anyone had luck with noninvasive testing on getting a diagnosis?

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