It is important to note that the process of mast cell activation can occur in anyone, even without a mast cell disorder, as well as in patients with both mastocytosis and MCAS.
This can be seen in patients with primary Lyme disease. In these patients, MCA (mast cell activation) can be a coexisting condition.
What is Lyme disease?
From the Centers for Disease Control:
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.
Many of us with mast cell disease, myself included, wonder if we have Lyme disease because the symptoms can be so similar. We often have it ruled in or out in our path to being diagnosed. For those who have tested positive for Lyme disease, mast cell activation and cytokine release may occur because the bacteria that causes Lyme (and also syphilis) may trigger a (sometimes severe) immune system response.
According to research published on PubMed:
Acute, subacute, or chronic persistent human Lyme borreliosis is an inflammatory disorder composed pathologically of lymphocytes, plasma cells, macrophages, and mast cells. The lymphoplasmocellular infiltrates can at times be seen in the skin, subcutaneous tissues, lymph nodes, spleen, liver, myocardium, brain, autonomic ganglia, and peripheral nerves. The joints in arthritic cases have proliferative synovitis, fibrinaceous deposits, lymphoplasmocellular aggregates, and mast cells. Varying degrees of vascular damage does occur in these sites; however, usually only in late, chronic disease. Spirochetes are present in most sites, in an extracellular location, but are sparse.
Here is another research paper describing this connection:
The Lyme disease spirochete, Borrelia burgdorferi, is introduced into human hosts via tick bites. Among the cell types present in the skin which may initially contact spirochetes are mast cells. Since spirochetes are known to activate a variety of cell types in vitro, we tested whether B. burgdorferi spirochetes could activate mast cells. We report here that freshly isolated rat peritoneal mast cells or mouse MC/9 mast cells cultured in vitro with live or freeze-thawed B. burgdorferi spirochetes undergo low but detectable degranulation, as measured by [5-3H] hydroxytryptamine release, and they synthesize and secrete the proinflammatory cytokine tumor necrosis factor alpha (TNF-alpha).
This research paper also describes how mast cells may slow the rate of the spread of the bacteria in an attempt to combat Lyme disease infection:
The absence of mast cells did not change the replication rate of Borrelia in the skin. However, in the absence of mast cells, Borrelia dissemination to the joints was faster. Mast cells do not control skin bacterial proliferation during primary infection and the establishment of the primary infection, as shown in the C57BL/6 mouse model studied. Nevertheless, the Borrelia induced cytotokine modulation on mast cells might be involved in long term and/or repeated infections and protect from Lyme borreliosis due to the development of a hypersensitivity to tick saliva.
The problem is, mast cell activation can create a whole subset of issues which can make things worse for the Lyme disease patient and may make it more difficult to find therapies that work. David Michael Conner writes about this in an article on The Huffington Post:
In short, the bacteria that cause Lyme disease also have been shown to trigger dysfunctional mast cell activation, and mast cell activation causes inflammation that can then bring about a great number of characteristic mild to life-threatening symptoms.
Treating the coexisting MCA may help the Lyme disease patient achieve better control over their disease. On a blog called LymeMD, Dr. Jaller details his account with a patient who has successfully been treated for mast cell activation possibly triggered by her Lyme disease by using a mast cell stabilizing drug, Ketotifen.
In summary, mast cell activation disorder, MCAD and Lyme can appear identical and Lyme may be a cause of MCAD. Diagnosing and treating this disorder can be invaluable.
These two conditions definitely need more research done to gain a better understanding of how they are connected.
You can learn more about Lyme disease at LymeDisease.org
You can learn more about MCAD at The Mastocytosis Society
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