Chronic fatigue due to Mast Cell Activation Syndrome?

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I thought I'd cite this paper I encountered today (not sure if they mean MCAS is included in their definition of Mastocytosis, but I have chronic fatigue issues and have been on an MCAS treatment plan for 2.5 months now, and it has clearly been quite helpful):

Clin Ther. 2019 Apr;41(4):625-632.
doi: 10.1016/j.clinthera.2019.01.016. Epub 2019 Feb 21.
Fatigue in Mastocytosis: A Case Series
Jens Vikse 1, Roald Omdal 2
Abstract
Purpose: Accumulating evidence suggests that fatigue in chronic inflammatory diseases is generated in the brain by mechanisms involving proinflammatory cytokines. We recently reported a high prevalence of fatigue in patients with mastocytosis, a condition with a constant activation of mast cells and release of a variety of bioactive substances. This observation indicates that mast cells somehow could be involved in the biological mechanisms that generate fatigue. In this case series, we aim to describe how typical triggering factors of mastocytosis attacks, as reported by patients, are accompanied by increased fatigue. Possible mechanisms by which mast cells may contribute to the pathophysiology of fatigue are discussed.
Methods: Seven patients with mastocytosis were interviewed regarding triggers and clinical symptoms and signs of mastocytosis, including the presence and severity of fatigue. Fatigue severity during and between attacks was assessed using the fatigue Visual Analog Scale (fVAS).
Findings: The most important reported triggers were heat and/or cold, exercise, food, alcohol, and psychological stress. The median fatigue Visual Analog Scale scores were 80 (range 40-91) during attacks and 40 (range 30-72) between attacks Fatigue reportedly impaired social and recreational activities in all 7 patients, and influenced occupational activities in 6.
Implications: This case series illustrates that fatigue is common and severe among patients with mastocytosis. Fatigue increases during attacks, which may indicate that mast cell-derived substances are directly involved in the pathophysiology of fatigue. Mast cells could be an underestimated cellular actor in fatigue and other conditions and thus may represent a potential therapeutic target.
Keywords: activities of daily living; fatigue; mast cells; mastocytosis; quality of life.
 
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I think it should be : "This observation indicates that mast cells somehow could be involved in the a biological mechanism that generates fatigue." Immune system activation may be involved in many forms of fatigue, but that doesn't mean that mast cells are involved in all of those. Something that triggered only microglia or even on of those glial types that is highly localized in the brain, might also produce fatigue.
 
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I looked for photographs on google about the Mastocytosis ( never heard the word before ), one of the photos is an almost exact match for the 'fairy rings' that I get on my hands at certain times ( the worst of it correlated with the most severe time ). Mine are just a color change and can't be felt, nor do they hurt to touch, and can join up or take the form of a large red patch rash picture from google images

I also get something similar which does hurt, its more like a burn, but its only in a very specific place on the sides of each index finger, I went to the doctor once and they said it looks like a chemical burn.