Can Cannabis Help Mast Cell Activation Syndrome?

More people are talking about mast cell activation syndrome (MCAS) now than ever. The condition, marked by unexplained bouts of symptoms like swelling, diarrhea, vomiting, flushing, and itching, scientists only gave the condition a modernized classification and diagnostic criteria when they gathered at a special conference in 2010.

Despite increased conversation around the condition through advocacy and internet spaces, we don’t know how many people truly have MCAS. In fact, studies have shown that MCAS is more commonly suspected than diagnosed—meaning other factors or triggers cause symptoms that are mistaken for MCAS. 

But those diagnosed with MCAS or histamine intolerance know all about the uncomfortable, painful symptoms it can cause. As awareness increases, more people are wondering if cannabis can help with MCAS. Let’s investigate. 

MCAS Diagnosis and Symptoms 

The symptoms associated with MCAS occur because of an inappropriate immune response. Mast cells are part of the immune system and help to protect the body from harmful pathogens. When they sense a trigger, they release histamine and other chemicals to activate the immune system. For people with MCAS, the body misinterprets various triggers and sets off an unnecessary immune response. 

MCAS is marked by repeated episodes of severe symptoms across multiple bodily systems. For MCAS diagnosis, patients must have symptoms in two or more bodily systems, including skin, respiratory, cardiovascular, and digestive systems. 

 The Cleveland Clinic recognizes the following MCAS symptoms:

• Low blood pressure (feeling dizzy or lightheaded)
• Flushing (hot, red, or pink skin)
• Itchy skin
• Hives
• Nasal congestion
• Swelling, often of your face, lips, eyes, tongue or throat (angioedema)
• Constipation or diarrhea (sometimes alternating)
• Abdominal (belly) pain
• Vomiting
• Shortness of breath
• Weakness or fainting
• Anaphylaxis (severe allergic reaction, which may include a combination of the above symptoms)

To receive a diagnosis, healthcare providers will look at symptoms and evaluate how you react to MCAS treatment and tests. Doctors may also request blood tests like tryptase and immunological studies, and rule out other allergens through skin testing. 

MCAS Treatment 

To manage an MCAS episode, experts recommend following the same protocols for anaphylaxis, starting with epinephrine, if symptoms are severe. In the long-term, antihistamines are also recommended to help with itching, abdominal discomfort, and flushing. Experts recommend second-generation antihistamines (like loratadine and cetirizine) over first-generation (like hydroxyzine and diphenhydramine) because they have fewer side effects. 

There are also more ways to help manage specific symptoms. For example, aspirin also blocks the production of prostaglandin D2, which can help reduce flushing. Additionally, drugs like montelukast and zafirlukast can help reduce wheezing and abdominal cramps. 

Omalizumab may help to reduce reactivity and mast cell activation, reducing the occurrence of anaphylaxis. As a last resort for edema, hives, and wheezing, patients can use corticosteroids. 

Cannabis for MCAS: The Science 

Given MCAS awareness has only recently increased, some people with the condition are looking for alternative ways to manage symptoms. This is especially true for people who have negative reactions to prescribed medications or are seeking additional support. 

Like many conditions, there is not a lot of research to back up the use of cannabis for mast cell activation syndrome. However, this does not mean there is no potential for the two to work together. 

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It’s generally accepted that cannabinoids are immunosuppressive and anti-inflammatory. Cannabinoid receptor 2 (CB2) is a typical constituent of immune system cells. Interestingly, researchers have also established that cannabinoid receptor 1 (CB1) is expressed in mast cells. 

The recent discovery that the immune system uses both types of cannabinoid receptors opens the door to many potential new immune system-related treatments with cannabis. This could potentially include mast cell activation syndrome and co-occurring symptoms like chronic pain, heightened anxiety, neurological symptoms, or mood disorders. 

In one study, researchers found that CB1 receptors help down-regulate mast cell activation. This means CB1 activators like THC could help to reduce the inflammatory response brought on by mast cell activation, particularly with psoriasis and some forms of dermatitis. 

Likewise, cannabidiol (CBD) may play an important role in MCAS relief. We have evidence that CBD may induce activation of receptor protein PPARy, which can suppress immune system reactions. Additionally, because cannabidiol can inhibit certain enzymatic activity, research indicates that CBD may effectively treat mastocytosis-related pain. 

Anecdotal Evidence of Cannabis for MCAS

While we have some supportive scientific evidence revealing that cannabis may help with MCAS, we have even more anecdotal, real-world evidence. We hope to see more scientific studies emerge that can help us make sense of the anecdotal cases. 

Ticked Off Mast Cells, a resource group for people with mast cell and tick-borne diseases, conducted a survey to get a better idea of how medical cannabis can help with MCAS. They surveyed 114 people diagnosed with (72%) or suspected to have (28%) MCAS. Respondents ranged from 18 to 75 years of age, with the majority (91%) identifying as female. 

Survey results indicated that 85% of respondents found improvement when treating their MCAS with tetrahydrocannabinol (THC). This was a significantly higher success rate than any other treatment listed in the survey. 

Of the many symptoms respondents reported on, 46% stated that cannabis helped the most with skin itching, swelling, hives, and rashes. As for abdominal symptoms like cramping, diarrhea, nausea, and vomiting, 77% of respondents found symptom relief with cannabis. The survey results showed respondents found relief from several other symptoms, including nervous system issues, pelvic pain disorders, asthma-like symptoms, and many others. 

Final Thoughts on Cannabis for MCAS

While we have a decent amount of scientific and anecdotal evidence suggesting that cannabis may help with symptom relief for MCAS, know that none of the information in this article should be taken as medical advice. If you are wondering about using cannabis for MCAS, be sure to speak with your healthcare provider to see if it may be a good fit. 

If you decide to try it, be prepared for some trial and error. Across MCAS spaces on the internet, some patients mention that certain consumption methods can actually cause person-specific reactions. However, everyone’s immune system is different and some are hypersensitive or even paradoxical – we simply do not have enough understanding at this time to know why few react negatively. Regardless, you may find that certain methods work better for symptom control than others.

Respondents of the aforementioned survey noted the most symptom relief from indica strains, at 64%. An additional 45% reported success with hybrid strains, and 29% reported success with sativa strains. This may be because indica strains carry particular terpenes that cause their characteristic effects; it may be smart to look for similar terpene profiles in cannabis products – but there is no clinical research on this yet.

We look forward to seeing more published scientific studies examining the relationship between cannabis and MCAS. In the meantime, we hope that patients looking for relief from symptoms are equipped with more knowledge to decide if cannabis is right for them.