@dr.zac.spiritos: Once you diagnose MCAS, that can actually be the easy part. The harder part is often figuring out how to treat it. We have medications that, in theory, should help stabilize mast cells or block the mediators they release. The operative words are in theory—because mast cells do not always follow the playbook. Someone may react to the medication itself. They may react to a dye, filler, preservative, or another excipient in the formulation. And for someone who has had repeated bad experiences with medications, the stress and anticipatory anxiety around taking something new can sometimes amplify symptoms even further. So getting medication into an already highly reactive system can require a lot more troubleshooting than simply picking the “right” drug. Sometimes that means compounding a medication to remove unnecessary additives or starting at a fraction of the usual dose. A liquid formulation can make it much easier to start extremely low and slowly work upward. Other times, we switch medications entirely, change the formulation, or even change the route of administration—occasionally an injectable medication is tolerated better than an oral one. This is why MCAS care often requires close follow-up and a willingness to adjust the plan. The diagnosis gives you a framework. The real work is figuring out what that individual person’s body will tolerate, finding a way to get treatment on board, and slowly building from there. #mcas #dysautonomia #heds #pots #mastcellactivationsyndrome

Dr. Zac Spiritos

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Monday 14 September 2026 22:34:09 GMT