Bendy Bodies with Dr. Linda Bluestein

Mast Cell Activation Syndrome: The Diagnosis Most Doctors Miss with Dr. Lawrence Afrin (Ep 181)

10 snips
Jan 29, 2026
Lawrence Afrin, internist and leading mast cell disease expert, explains why mast cell activation syndrome is often missed. He discusses how MCAS can present very differently between people. Conversations cover why tryptase testing alone fails, MCAS links to neurologic and psychiatric symptoms, connections with hypermobile EDS, and emerging treatments like GLP-1 agents.
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INSIGHT

MCAD As The Overarching Framework

  • Mast cell disorders are best seen under the umbrella term MCAD because inappropriate mast cell activation drives most symptoms.
  • MCAS is the dominant form with activation but little-to-no mast cell proliferation.
INSIGHT

HAT Raises Baseline Tryptase

  • Hereditary alpha-tryptasemia (HAT) comes from extra TPSAB1 gene copies raising baseline tryptase slightly.
  • Most HAT cases cause modest tryptase elevation that usually does not produce clinical problems.
INSIGHT

Think MCAS With Multisystem Inflammation

  • Mast cells produce a huge variety of mediators causing inflammatory, allergic, and growth effects across body systems.
  • Chronic multisystem inflammation should prompt clinicians to consider MCAS in the differential.
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