Comprehensive Mast Cell Disorder Management

Mast Cell Disorder Specialist in New Orleans

Dr. Reena Mehta is a board-certified allergist / immunologist that specializes in mast cell disorders in New Orleans, LA. Dr. Mehta can help you thrive over mast cell disorders like mastocytosis and mast cell activation syndrome (MCAS).

“Dr. Reena Mehta is a world-class physician. She is prompt, thorough, kind, patient, diligent, professional and brilliant. Yet, what amazes me the most is her devotion and resourcefulness as she tirelessly journeys through my complex medical history while facilitating my current special needs as a patient with a mast cell disorder. She is the answer to my prayers for a local, eager, tenacious, and receptive mast cell specialist.“

– Lea F, June 2019

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Mast cell disorder specialist Dr. Reena Mehta in New Orleans, LA

What are Mast Cell Disorders?

Overview

Symptoms

Diagnosis

Management

Mast cells are immune cells throughout the body that produce allergic response mediators when activated. One such mediator is histamine. In a healthy individual, mast cells are activated to defend against harmful bacteria, parasites, fungi, viruses, and and other pathogenic substances.

Broadly speaking, mast cell disorders describe conditions that are related to the overreaction or inappropriate activation of mast cells, causing symptoms similar to a severe allergic reaction. Mast cell disorders can occur in both children and adults.

Mastocytosis

Mastocytosis occurs when mast cells are present in greatly increased numbers and, as a consequence, release an excessive amount of allergic response mediators when activated by dietary or environmental triggers.

Mast cell disorder spots on the arm of a patient in New Orleans, LA

Mast Cell Activation Syndrome (MCAS)

Mast cell activation syndrome describes the inappropriate activation of mast cells with little or no observed increase in the number of mast cells throughout the body. Inappropriate triggers can include different foods, chemicals, fragrances, exercise, or stress. MCAS is not caused by an allergy nor is it secondary to other conditions that are known to activate normal mast cells.

Mast Cell Disorders, Hypermobile Ehlers-Danlos Syndrome, and Postural Orthostatic Tachycardia Syndrome

Recent research has revealed a possible new disease cluster involving mast cell activation disorders, postural orthostatic tachycardia syndrome (POTS), and Hypermobile Ehlers-Danlos syndrome (hEDS).

Hypermobile Ehlers-Danlos Syndrome (hEDS) is a rare inherited condition that affects connective tissue, resulting in very flexible joints and stretchy skin that breaks easily. This connective tissue disease can also affect other systems in the body including the digestive tract (heartburn, constipation), the heart (mitral valve prolapse), the bladder (stress incontinence), and other organs (organ prolapse).

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that causes an abnormal increase in heart rate after sitting up or standing. Patients with POTS often tend to describe discomfort when their heart rate increases, and can also experience lightheadedness and fainting. Symptoms are usually alleviated by sitting or lying back down.

In a study published in 2015, patients having a diagnosis of POTS and EDS were given a screening questionnaire to look for symptoms consistent with MCAS, and 66% of the respondents reported such symptoms. While much about these conditions and the nature of the relationships between them remain unknown, many researchers and medical professionals are now looking at these conditions together as a unique syndrome that’s relatively common in individuals with mast cell disorders.

Mast Cell Disorder Symptoms

Mastocytosis Symptoms

Mastocytosis can appear as distinct “spots” that look like freckles. These spots are called urticaria pigmentosa, and they can transform into hives and itch if stroked or irritated, or if the skin is exposed to sudden changes in temperature such as a hot shower.

Other symptoms of mastocytosis include:

Anaphylaxis (severe allergic reaction)
Shortness of breath
Low blood pressure
Hives and swelling
Itching
Nausea and vomiting
Diarrhea
Fainting
Headache
Uterine cramps / bleeding
Flushing
Musculoskeletal pain

MCAS Symptoms

An individual with MCAS often experiences repeated episodes of anaphylaxis that can affect different organ systems in the body. These include:

Heart related symptoms: rapid pulse, low blood pressure, passing out
Skin related symptoms: itching, hives, swelling, red skin
Lung related symptoms: throat swelling, wheezing, shortness of breath, harsh noise when breathing
Gastrointestinal tract symptoms: diarrhea, nausea with vomiting, crampy abdominal pain

Mast Cell Disorder Diagnosis

Mastocytosis Diagnosis

If you suspect that you have a mast cell disorder, it’s important to seek care from an allergist / immunologist that is a mast cell disorder specialist. Diagnosis of mastocytosis can include:

Blood counts
Measurement of mast cell mediators in blood and urine
Skin and bone marrow biopsies
Liver function studies
Genetic tests

MCAS Diagnosis

Diagnosis of MCAS can require measurement of mast cell mediators during symptomatic episodes and at baseline to look for elevations during symptoms. In many cases, an MCAS diagnosis is confirmed by successful treatment with mast cell mediator inhibitors.

Blood test for mast cell disorder in New Orleans, LA

Mast Cell Disorder Treatment & Management

Mastocytosis Management

Effective mastocytosis management relies on controlling the effects of mast cell mediators and avoiding dietary and environmental triggers. Mediator inhibiting medications include:

Antihistamines
Cromolyn sodium
Ketotifen
Leukotriene-modifying agents

More aggressive forms of mastocytosis may require interferon, immune modulators, or chemotherapeutic agents. Individuals with mastocytosis should also be prepared with epinephrine in cases of low blood pressure.

MCAS Management

The goal of MCAS treatment is to confirm diagnosis and provide relief from anaphylactic events.

Certain antihistamine medications (type 1 receptor blockers) can be effective for itching, abdominal discomfort, and flushing, while others (type 2 receptor blockers) can help with abdominal pain and nausea
Aspirin can reduce flushing
Montelukast and zafirlukast can help reduce wheezing and abdominal cramping
Corticosteroids can be helpful for edema, hives, and wheezing
Omalizumab may help reduce anaphylactic episodes

If these treatments are ineffective, it’s unlikely that you have MCAS.

See a Mast Cell Disorder Specialist in New Orleans

If you suspect that you or your child are living with a mast cell disorder, it might be time to see a mast cell disorder specialist. Dr. Mehta has a reputation for developing strong relationships with her patients and being exceptionally attentive to their needs and concerns.