At 37:37 on, Anne Maitland, a leading MCAS doc and researcher, makes points that go along with my misgivings about some of the uses of concepts of mcas.
1. Immune deficiencies often correlate with mcas. That's not a contradiction but some of the simplistic ideas about mcas assume that mast cells are just overreacting for no reason and we need to nuke them with chemo or steroids. If there's an immune deficiency leading to mast cells and other innate immune cells "compensating" by being overactive , as maitland says, then treading carefully when it comes to immune suppression is warranted. Of course if you're having anaphylaxis it's onething , but not everyone, especially people with immunoglobulin deficiencies and infections, needs steroids or strong chemo drugs sometimes used in mastodon.
2. Mast cells are not the only cells involved in innate immune dysfunction and we sometimes hyper focus on them because the idea of the disorder is like a meme that causes us to hyper focus on that. Pretty sure she says that here, but if she doesn't, I may be remembering her saying it on a podcast by the center for healing neurology. These podcasts are free on spotify, and would provide additional context to the point I'm making. Yes mast cells are important but we're talking about broader patterns of innate immune dysfunction. Which includes glial cells, maybe astrocytes. Macrophages too. And yes, mast cells. But why focus on a single type of cell?
Also why is the innate immune system compensating? As someone with many documented immune deficiencies , such as IgG deficiency and iga deficiency, I'd like to know.
3. We should also focus on other comorbid things like immune mediated neuropathies