Archive for the ‘Viruses’ Category

Review of Tick Attachment Time For Different Pathogens

http://dx.doi.org/10.3390/environments4020037

Stephanie L. Richards, Ricky Langley, Charles S. Apperson and Elizabeth Watson 

Abstract

Improvements to risk assessments are needed to enhance our understanding of tick-borne disease epidemiology.

We review tick vectors and duration of tick attachment required for pathogen transmission for the following pathogens/toxins and diseases: (1) Anaplasma phagocytophilum (anaplasmosis); (2) Babesia microti (babesiosis); (3) Borrelia burgdorferi (Lyme disease); (4) Southern tick-associated rash illness; (5) Borrelia hermsii (tick-borne relapsing fever); (6) Borrelia parkeri (tick-borne relapsing fever); (7) Borrelia turicatae (tick-borne relapsing fever); (8) Borrelia mayonii; (9) Borrelia miyamotoi; (10) Coxiella burnetii (Query fever); (11) Ehrlichia chaffeensis (ehrlichiosis); (12) Ehrlichia ewingii (ehrlichiosis); (13) Ehrlichia muris; (14) Francisella tularensis (tularemia); (15) Rickettsia 364D; (16) Rickettsia montanensis; (17) Rickettsia parkeri (American boutonneuse fever, American tick bite fever); (18) Rickettsia ricketsii (Rocky Mountain spotted fever); (19) Colorado tick fever virus (Colorado tick fever); (20) Heartland virus; (21) Powassan virus (Powassan disease); (22) tick paralysis neurotoxin; and (23) Galactose-α-1,3-galactose (Mammalian Meat Allergy-alpha-gal syndrome).

Published studies for 12 of the 23 pathogens/diseases showed tick attachment times. Reported tick attachment times varied (<1 h to seven days) between pathogen/toxin type and tick vector. Not all studies were designed to detect the duration of attachment required for transmission. Knowledge of this important aspect of vector competence is lacking and impairs risk assessment for some tick-borne pathogens.

**Highlights**

The researchers point out that unlike mosquitoes which rely on saliva for transmission, ticks can transmit via saliva, regurgitation of gut contents, and also via the cement-like secretion used to secure itself to the host (hard ticks).  Published data on transmission times relies upon rodent studies showing 15–30 min for Powassan, anywhere from 4-96 hours for bacteria, 7–18 days for the protozoan Babesia microti, and 5-7 days for neurotoxin (Tick Paralysis). For soft ticks, attachment time of 15 sec–30 min was required for transmission of Borrelia turicata (Tick Relapsing Fever).

The challenge with these studies, and there are many, is that most placed multiple ticks on multiple rodents.  Multiple ticks may be transmitting different pathogens.  It has also been shown that ticks feeding on mice coinfected with B. microti and B. burgdorferi were twice as likely to become infected with Bb compared to B. microti, suggesting that coinfection can amplify certain pathogens – which is another reason to only use one rodent and one pathogen to separate out multiplying factors to muddy the waters.  Also, rarely do studies record the titer of both tick and host – again, making it nearly impossible to determine what’s what.  It was also noted that transmission times are unknown for many pathogens.

**And as always:  if you are the ONE person who contracted Lyme Disease in 10 minutes, all these numbers are essentially meaningless.  The frightening truth is that these numbers, along with geographical information regarding tick habitats, are often used against patients.  It is beyond time for doctors to listen, educate themselves, and treat patients with the respect they deserve – not to mention it’s time for them to treat patients clinically and not based on tests that are wrong over half the time and with the knowledge that ticks are spreading everywhere and bringing the pathogens with them. (In other words, throw the maps away!)

The review essentially gives the following transmission times for various pathogens. Again, please know these numbers are not definitive and many, many cases have proven this fact.

Take each and every tick bite seriously and don’t mess around and take a “wait and see approach.”  There is too much at stake.

Transmission Times noted in review:

Anaplasmosis: 24 hours and increased dramatically after 48-50 hours.  It is possible for it to be transmitted transovarially (from mom to baby tick) and it inhabit’s the salivary glands more frequently than the mid-gut.

Babesiosis:  Greater than 36 hours, 17% after 48 hours, and 50% after 54 hours.  Can be transmitted transovarially and transstadially (pathogen stays with tick from one stage to the next).  Ticks feeding on mice coinfected with B. microti and B. burgdorferi were twice as likely to become infected with Bb compared to B. microti.

Lyme Disease (Borrelia burgdorferi):  24 hours; however, the researchers comment that there are questions regarding previous transmission studies.  They also commented that there may be a difference in attachment time between nymphs and adult females. Transovarian transmission is unknown.

Tick Relapsing Fever (Borrelia turnicatae, B. hermsii):  15 and 30 seconds respectively.  Transovarian transmission is unknown.

Borreliosis (Borrelia mayonii):  24 hours.  Transovarian transmission is unknown.

Borrelia myamotoi Disease:  24 hours.  Transovarial transmission occurs.

Tularemia (Francisella tularensis):  Not assessed.  Can be transmitted mechanically by deer flies, horse flies, mosquitoes, aerosol/ingestion when processing/eating infected animal tissues.  Can be transmitted transtadially and transovarially.

Rocky Mountain Spotted Fever (Rickettsia rickettsii):  10-20 hours.  Can be transmitted transovarially.

Heartland Virus:  Not assessed.  Can be transmitted transovarially and transstadially.

Powassan Virus:  15 Minutes; however, it is possible it was sooner since the first they checked for transmission was 15 minutes.  Can be transmitted transovarially.

Tick Paralysis (Neurotoxin):  2-6 days.

Alpha Gal/Mammalian Meat Allergy (Galactose-a-1,3-Galactose):  Not assessed.  Transovarian transmission is unknown.

For more on transmission times, please read:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/

 

 

Powassan and Bb Infection in Wisconsin and U.S. Tick Populations

http://online.liebertpub.com/doi/full/10.1089/vbz.2016.2082

Powassan/Deer Tick Virus and Borrelia Burgdorferi Infection in Wisconsin Tick Populations

Knox Konstance K., Thomm Angela M., Harrington Yvette A., Ketter Ellen, Patitucci Jacob M., and Carrigan Donald R. Vector-Borne and Zoonotic Diseases. May 2017 Online Ahead of Print

ABSTRACT
Powassan/Deer Tick Virus (POWV/DTV) is an emerging cause of arboviral neuroinvasive disease in the upper Midwest. These studies describe the prevalence and geographic distribution of Wisconsin ticks carrying POWV/DTV as well as the high frequency of Ixodes scapularis ticks coinfected with both POWV/DTV and Borrelia burgdorferi, the causative agent of Lyme disease. These findings suggest that concurrent transmission of POWV/DTV and B. Burgdorferi from coinfected ticks is likely to occur in humans.

Results (see link for maps and graphs of locations and results)

The distribution of I. scapularis and D. variabilis tick collection sites are categorized by geographic quadrant (QNW, QNE, QSW, & QSE) of the state (Fig. 1, Table 1). Nearly 80% of adult female I. scapularis ticks analyzed were collected from the northern half of the state (QNW and QNE) and accounted for 85% of POWV-positive ticks. While only 90 I. scapularis ticks were collected from the southern two quadrants, POWV-positive ticks were identified in both QSE and QSW. QNW I. scapularis ticks revealed the highest MLE of infection for both POWV and B. burgdorferi (4.67% and 23.42%, respectively). A separate analysis of I. scapularis collections from Harvest One endemic zone (Spooner/Hayward) QNW demonstrated a frequency of infection for both POWV (4.65%) and B. burgdorferi (27.91%) that is comparable to the total QNW (Fisher’s exact, p = 1.00 and p = 0.35, respectively). QSE contained the lowest MLE for POWV (1.53%), but B. burgdorferi-infected ticks were high with a MLE of 15.69%. Of the 295 D. variabilis ticks analyzed from both harvests, none (0%) had evidence of POWV infection; however, B. burgdorferi infection in D. variabilis ticks was seen in both QNW (3.1%) and QSW (2.86%), consistent with the high B. burgdorferi infection rate observed in I. scapularis ticks in these same quadrants.

http://online.liebertpub.com/doi/full/10.1089/vbz.2017.2110

Powassan Virus: An Emerging Arbovirus of Public Health Concern in North America

Hermance Meghan E. and Thangamani Saravanan. Vector-Borne and Zoonotic Diseases. May 2017 Online Ahead of Print

ABSTRACT
Powassan virus (POWV, Flaviviridae) is the only North American member of the tick-borne encephalitis serogroup of flaviviruses. It is transmitted to small- and medium-sized mammals by Ixodes scapularis, Ixodes cookei, and several other Ixodes tick species. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV is the causative agent of a severe neuroinvasive illness with 50% of survivors displaying long-term neurological sequelae. POWV was recognized as a human pathogen in 1958 when a young boy died of severe encephalitis in Powassan, Ontario, and POWV was isolated from the brain autopsy of this case. Two distinct genetic lineages of POWV are now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. In the past 5 years, both basic and applied research for POWV disease has intensified, including phylogenetic studies, field surveillance, case studies, and animal model development. This review provides an overview of POWV, including the epidemiology, transmission, clinical disease, and diagnosis of POWV infection. Recent research developments and future priorities with regard to the disease are emphasized.

Early timeline of POWV transmission
The duration of I. scapularis attachment required for successful transmission of DTV to a host was found to be as little as 15 min (Ebel and Kramer 2004). This finding was particularly striking because unlike other tick-borne pathogens (Borrelia burgdorferi, Babesia microti, and Anaplasma phagocytophilum), very little time between tick attachment and virus transmission is needed for POWV. The reactivation period required for some nonviral tick-borne pathogens provides a grace period of approximately 24 h, where a minimal risk of transmission occurs if humans remove the attached tick within this timeline; however, there is no such grace period for POWV due to its very short timeline of transmission. These differences underscore why the timeline of POWV transmission must be carefully considered when analyzing the early immunomodulatory events that occur at the feeding site of the tick.

**My comment**
The idea of a “grace period” is ludicrous. Ticks do not understand grace, trust me. For accurate information about transmission times of Lyme see:
https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/.  In short, it can happen in hours for sure – not requiring the oft repeated dogma of 24-48 or more hours.  Ticks often feed partially and then drop off.  These partially fed ticks have spirochetes in their saliva and can transmit much more quickly.

Every single tick bite should be taken seriously!

Chronic LD Summit #2

http://chroniclymediseasesummit2.com/?idev_id=11577&idev_username=Summit3  Please register at link.

Lyme disease is quickly spreading across the entire globe — very few are enlightened on this troublesome condition — that’s why Dr. Jay Davidson has urgently created the second summit on this topic (with only 2 repeat speakers from 2016). 300,000+ people per year contract Lyme, and 2017 is predicted by some to be an incredibly risky year!

The Chronic Lyme Disease Summit 2 is online and FREE from June 19-26, 2017.

Speakers and Topics:

Wayne Anderson, ND
Overview of Lyme and Its Evolution

James Maskell
Evolution of Medicine and Lyme

Scott Forsgren, FDN-P
Maximizing Lyme Disease Recovery

Philip Blair, MD
Col. US Army, ret.
Lyme Recovery with CBD

Jay Davidson, DC, PScD
Improving Lyme Disease Protocols

Jonathan Streit, DC
Testing for Functional Neurological Issues

Tyna Moore, ND, DC
Strength Training to Optimize Stem Cells

Sarah Ballantyne, PhD
Diet/Lifestyle as a Complementary Approach

Leslie Douglas, PhD
DNA Connexions PCR Assay

Greg Lee, MAc, BS
GoodbyeLyme™ Treatments and Remedies

Dave Ou, MD
Things Missed in the Treatment of Lyme

Evan H. Hirsch, MD, ABOIM
Coinfection Bartonella Treatment

Katie Dahlgren, ND
Helping Lyme Through Parasites

Shayne Morris, PhD, MBA, CNS
The Omics of Borrelia
Dietrich Klinghardt, MD, PhD
Latest on Lyme Testing and Treatments

Amy Derksen, ND
Non-Antibiotic Approaches to Treating Children

Dan Pompa, DPSc
Is Chronic Lyme Linked to Heavy Metals?

Todd Watts, DC
Killing Parasites to Kill Lyme Disease

Isaac Eliaz, MD, MS, LAc
Biofilm and Galectin-3 Breakthrough Strategies

Darin Ingels, ND
Herbal Therapy and Low Dose Immunotherapy (LDI)

Jerod Bergman, DC, CCSP, CSCS
Stopping EMFs and Geopathic Stress

Izabella Wentz, PharmD, FASCP
Thyroid and Lyme Disease

Tim Jackson, DPT, CNS(c)
Mitochondrial Dysfunction and Inflammatory Cytokines

Joette Calabrese, HMC, CCH, RSHom
Homeopathic Approach to Lyme Disease

David A. Jernigan, DC
Unique Approach to Healing

Gerry Curatola, DDS
Microbiome of Your Mouth

Jonathan Landsman
Fixing Toxic Teeth and Gums

Jill Carnahan, MD, ABFM, ABIHM, IFMCP
CIRS and Lyme Disease

Christine Schaffner, ND
Healing Your Brain from Lyme Disease

Diane V. Capaldi, MAP
Consciousness as It Relates to Healing

Jon Butcher
Repairing Relationships After Illness

Keesha Ewers, PhD, ARNP
Feeling Betrayed by Your Body?

Kim D’Eramo, DO
Mindsets That Impair Immune Function

Dana Walsh & Brent Martin
How to Lyme Less and Live More!

Sarah Schlichte Sanchez
Fighting as a Mindset

Powassan – Another Reason to Avoid Ticks

Powassan Virus Is the Scary New Reason to Avoid Ticks
Amanda MacMillan
May 04, 2017

For more, visit http://time.com/time-health/.

http://time.com/4767290/powassan-virus-ticks/ (Video here)

Lyme disease isn’t the only tick-borne illness that can come from a walk in the woods. Health experts are warning that another pathogen, Powassan virus, can cause dangerous inflammation in the brain and may be transmitted to humans much faster than Lyme. While it is rare, a recent study of ticks in Maine, along with a few widely reported cases of human infection, suggest that it may be becoming more common. /react-text

What is Powassan virus?

The virus causes encephalitis, or swelling of the brain, and it kills about 10% of people who become sick, https://www.cdc.gov/powassan/symptoms.html.
About half of people are left with permanent neurological problems.

Powassan virus was first identified in 1958 and was first recognized in deer ticks, the type that bite humans and also carry Lyme disease, in the mid-1990s. About 75 cases have been reported to the CDC over the last 10 years, and most have been in the Northeast and the Great Lakes region. https://www.cdc.gov/powassan/statistics.html

One of those cases, in 2013, was a woman in Maine who died a few weeks after being bitten by a tick and contracting Powassan virus. Her diagnosis, along with two subsequent cases in the same county, prompted scientists at the Maine Medical Center Research Institute to test ticks at various sites across the state.

The researchers released their preliminary findings in April and told Bangor Daily News that, “We were kind of surprised that we found as much as we did.” Out of 203 different pools of adult ticks—meaning all of the ticks collected from a given area—15 tested positive for Powassan. The researchers also found that populations of deer ticks were increasing in several areas in the state. http://vitalsigns.bangordailynews.com/2017/04/26/home/tick-researchers-found-powassan-virus-in-these-maine-towns/

Another recent CDC case report detailed the first-ever diagnosis of a human Powassan infection in Connecticut: a 5-month-old baby who was admitted to the hospital in November 2016 for vomiting, fever and seizures. The baby’s parents reported that he had been bitten by a tick about two weeks earlier and estimated that the tick bad been attached for less than three hours. The baby spent a week in the hospital, and it took several months for him to fully recover.  https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a3.htm?s_cid=mm6615a3_w#contribAff

Should you be worried about Powassan virus?

This news, coupled with experts’ prediction that 2017 will be an especially bad year for ticks in the Northeast, is cause for concern. So is the fact that Powassan is deadlier than Lyme disease—and appears to be transmitted much faster. In animal studies, Powassan virus could be passed from tick to host after only about 15 minutes of attachment. For Lyme disease, it takes 24 hours. http://www.npr.org/sections/goatsandsoda/2017/03/06/518219485/forbidding-forecast-for-lyme-disease-in-the-northeast

***This statement about Lyme transmission time is not accurate.  Please see this article:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/***

But Rafal Tokarz, associate research scientist at the Columbia University Mailman School of Public Health, stresses that Powassan is still very rare, and says it’s too early to know for sure if Powassan is truly becoming more prevalent.

Tokarz’s own research, mostly on ticks in regions around New York City, has shown that only about 1% to 2% of ticks are infected with bacteria that cause the Powassan virus. That finding is consistent with most studies that have been done in other parts of the country, he says.  https://www.mailman.columbia.edu/public-health-now/news/scientists-uncover-details-rise-tick-borne-disease-long-island

MORE: A New Cause of Lyme Disease Has Been Discovered
http://time.com/4212500/a-new-cause-of-lyme-disease-has-been-discovered/?iid=sr-link6

The recent report from Maine suggests higher numbers, but Tokarz points out that the researches tested entire pools at once. So while about 7% of tick pools tested positive for the virus, “there is no way to know how many ticks in each pool were infected,” he says. “It could be one out of 100, or it could be all 100.”

Nicholas Bennett, medical director of infectious diseases & immunology at Connecticut Children’s Medical Center, says that an increase in reported Powassan cases may also be due to more doctors being aware of the virus and actually testing for it. Like all tick-borne diseases, he says, the CDC’s numbers are probably much lower than the actual number of infections that occur each year, because many go unsolved or misdiagnosed. In November, Bennett was instrumental in getting that 5-month-old baby tested and diagnosed at Connecticut Children’s. “I may have been the first doctor to pick up on a case of Powassan in this state, but I’m sure it wasn’t the first to see a case in this state,” he says. “This isn’t a virus that’s on our standard list of tests, or that we look for automatically.”

And while some Powassan infections become very serious, many other people only develop a mild illness or have no symptoms at all.

More research is needed to determine how worrying Powassan is. But, Bennett says, research does suggest that tick populations and tick-borne diseases in general are on the rise.

What to do if a tick bites you

If you are bitten by a tick, rushing to the doctor right away won’t do you much good, Bennett says. The tests for these viruses aren’t pleasant—they involve blood and spinal-fluid drawings—and may not show signs of infection for several days or weeks.

MORE: Why Bed Bugs Are Becoming So Much Harder to Kill
http://time.com/4733708/bed-bugs-insecticide-resistance/?iid=sr-link1

“It’s perfectly reasonable to wait and see if you develop symptoms,” he says. There’s not much doctors can do for people who aren’t seriously ill, anyway. Doctors do not have a cure for Powassan and can only monitor the symptoms and provide care like respiratory support and IV fluids.

“The good news is that if you or your child are feeling a little under the weather or have a low-grade fever, there’s a million other probably causes other than Powassan,” says Bennett. “But if there are neurological symptoms—weakness, dizziness, seizures—then it’s important to get to the doctor.”

How to avoid ticks

The CDC says that people should protect themselves from Powassan virus the same way they do other tick-borne illnesses: by wearing insect repellant when spending time in areas where ticks are present, inspecting clothing and skin afterward and bathing or showering upon returning home. If pets have been outdoors, make sure they’re inspected regularly as well.  https://www.cdc.gov/ticks/avoid/on_people.html

“Take precautions and be on the lookout for ticks whenever possible,” Tokarz says. “Whether it’s Powassan or something more common like Lyme or another tick-borne disease, you really don’t want to get any of them.”

 

More Powassan in Maine

http://vitalsigns.bangordailynews.com/2017/04/26/home/tick-researchers-found-powassan-virus-in-these-maine-towns/

Since 2013, when a Maine woman died from Powassan, two more cases have been reported there and have caused encephalitis, but thankfully, not death.

This has prompted a statewide survey to discern just how many Maine ticks carry it. The researchers were surprised at the results.  Results here:  https://drive.google.com/file/d/0ByNSaqVer3roR3QxQTU2MGRDbTQ/view

All three contracted Powassan during the adult tick seas in fall and early spring and 7% of the adult ticks carried the virus.  To date, Powassan has been found in the deer tick (deer tick virus) as well as the groundhog or woodchuck tick.  There’s evidence both strains are in Maine.

For more on Powassan:  https://madisonarealymesupportgroup.com/2016/02/21/powassan-virus/

While transmission time for Powassan has been established to occur within about 15 minutes, I was very thankful that the article gave both the official word on transmission times for Lyme Disease (the erroneous 36-48 hours or more) as well as a link to an article about Dr. Nevena Zubcevik which debunks numerous myths, including the “official” transmission time myth. http://www.mvtimes.com/2016/07/13/visiting-physician-sheds-new-light-lyme-disease/

I recently wrote about this myth that needs to die:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/  (Includes a great video by microbiologist Holly Ahern explaining in layman’s terms about transmission times and what the studies actually say)

First Case of Powassan in Connecticut in a Five Month-Old Baby

https://www.washingtonpost.com/news/to-your-health/wp/2017/04/20/a-rare-tick-borne-disease-infected-a-baby-the-first-case-in-a-new-state/?utm_term=.ee921d023ecb by Lena H. Sun

Two weeks after pulling a tick off that had only been attached for 2-3 hours, a five month  old baby developed a fever, vomiting, facial twitching, and seizures.  A brain MRI showed inflammation deep in the brain.

Thankfully, the physician in charge studied in Upstate New York and was familiar with Powassan – a virus which can be fatal in up to 10 percent of cases.

For more on Powassan symptoms and treatment:  https://madisonarealymesupportgroup.com/2016/02/21/powassan-virus/

Unfortunately, the article by Sun repeats the oft repeated transmission myth that a tick needs to be attached for days to transmit Lyme Disease.  While it’s true that viruses, such as Powassan can be spread in minutes, Lyme Disease has been spread in hours:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/  A minimum time has never been established.  We don’t even know how long it takes other coinfections to be transmitted as well as nematodes, funguses, and other bacteria/protozoa.  Please remember a tick transmits many pathogens when it bites.

She also wrongly states that only the CDC can test for Powassan.  Right here in good old Wisconsin, Coppe Labs can test for it as well.  http://www.coppelabs.com/blog/powassan-virus-testing-available-in-march-2016/

A month after being sent home the baby couldn’t sit up anymore, but three months later his motor function returned to normal.

Sun also states that Powassan virus is rare.  I tend to agree with the physician who treated the baby that clinicians are probably only diagnosing the worst cases.  Folks that do not show symptoms, as in the case of many viruses, fly under the radar.  When bit by a tick; however, a pathogen invasion can trigger these normally benign viruses that are either lurking in the body or are transmitted at the same time as Lyme Disease and other pathogens.  I also agree with his statement that it is important to study Powassan in both ticks and people to determine just how prolific it really is.

 

 

 

Mast Cell Activation Syndrome & Lyme/MSIDS

The path to health leads many Lyme/MSIDS patients down numerous rabbit holes.  A pathogen invasion of various bacteria, funguses, viruses, and nematodes depletes the body of many important things.  We are literally being feasted upon, and patients find that they need to supplement their deprived bodies of many things after becoming infected.

Pathogen invasion also causes autoimmunity, where the body attacks itself. Cytokine cascades are continually being set off and the body is in a state of immunoconfusion with a pro-inflammatory response.  The immune system can no longer identify bad guys from good guys.  For many, getting the immune system straightened out is at least half the battle.

Mast Cell Activation Syndrome (MCAS) can cause these things as well.

Dr. Lawrence Afrin, M.D. wrote about MCAS in his book, Never Bet Against Occam.  In reading the book, it becomes clear there are as many nuances with MCAS as there are with Lyme/MSIDS.  Every patient is truly, uniquely different. In treatment, there is much trial and error, with each patient responding to differing things.

Our personal experience with MCAS stems from my daughter who developed allergy-type symptoms over years which came to a head with she developed severe Epstein Bar Virus (EBV).  Prior to that she would frequently have to stop running or walking due to severe itching (exercise induced urticardia).  http://www.mayoclinicproceedings.org/article/S0025-6196(11)63475-7/fulltext  Our LLMD uses LDA/LDI for those with immunoconfusion with success.  Although, she thankfully doesn’t present with Lyme/MSIDS, she definitely struggles with a confused immune system and EBV.  Read here for more on LDA/LDI:  https://madisonarealymesupportgroup.com/2016/05/30/new-kids-on-the-block-ldaldi/  In her case, she reacted strongly to the LDA.  The injections are  somewhat separated so you can visibly see what your issues are.  She developed a facial rash which was deep and painful.  Within a day of her shot it resolved completely, showing how skin symptoms can definitely be caused by allergens and immunoconfusion.

IMG_0475

https://www.linkedin.com/pulse/mast-cell-activation-syndrome-mcas-when-histamine-carnahan-md?trk=v-feed&lipi=urn%3Ali%3Apage%3Ap_flagship3_search_srp_content%3BH0Gf8FqaKVxrspeojT9VVA%3D%3D

Mast Cell Activation Syndrome (MCAS): When Histamine Goes Haywire…

Published on October 31, 2016
Jill C. Carnahan, MD – Used with permission
Founder, Medical Director, Flatiron Functional Medicine

Mast cells are present in most tissues throughout the human body, especially connective tissue, skin, intestinal lining cardiovascular system, nervous system, and reproductive organs. They are part of the allergic response designed to protect us from threat and injury. When the body is exposed to a perceived threat, the mast cells secrete chemical mediators, such as histamine, interleukins, prostaglandins, cytokines, chemokine and various other chemicals stored in the cytoplasm of the cell. These chemical messengers produce both local and systemic effects, such as increased permeability of blood vessels (inflammation and swelling), contraction of smooth muscle (stomach cramps and heart palpitations), and increase mucous production (congestion, sneezing, etc). Historically, we thought of mast cells only in relation to an allergic or anaphylactic response. We now know they play a profound role in immune activation, development of autoimmunity and many other disorders, such as POTS (postural orthostatic hypotension). Sadly we are seeing a large increase in patients presenting with mast cell disorders and MCAS. I believe it is in part do to the onslaught of more pervasive environmental toxins, molds and chemicals.

Without mast cells, we would not be able to heal from a wound. They protect us from injury and help the body to heal. Unfortunately, overactive mast cells can cause a variety of serious symptoms.

Symptoms of overactive mast cells may include:

skin rashes/hives
swelling/edema
flushing
itching
abdominal pain
nausea/vomiting
diarrhea
wheezing
shortness of breath
heart palpitations
anxiety, difficulty concentrating
headaches
brain fog
low blood pressure
fatigue

Mast cell activation syndrome (MCAS) is a condition symptoms involving the skin, gastrointestinal, cardiovascular, respiratory, and neurologic systems. It can be classified into primary (clonal proliferation or mastocytosis), secondary (due to a specific stimulus), and idiopathic (no identifiable cause). Proposed criteria for the diagnosis of MCAS included episodic symptoms consistent with mast cell mediator release affecting two or more organ systems with hives, swelling, flushing, nausea, vomiting, diarrhea, abdominal pain, low blood pressure, fainting, heart palpitations, wheezing, red eyes, itching, and/or nasal congestion.

Triggers may be medications, foods, supplements, hormones, opioids, stressors (physical or emotional), cold temperature, heat, pressure, noxious odors, chemicals, insect bites, trauma or environmental toxins.

We commonly see mast cell activation syndromes associated with CIRS (chronic inflammatory response syndrome) in response to biotoxins, such as mold, inflammagens, and lyme-related toxins.

Low MSH and Mast Cell Disorders?

As mentioned above, we frequently see histamine intolerance and MCAS in patients with mold-related CIRS (chronic inflammatory response syndrome). It is interesting to note that a common finding in CIRS is low MSH. According to this study in the Journal of Investigative Dermatology, alpha-MSH plays an immunomodulatory role during inflammatory and allergic reactions of the skin. In addition, there is evidence that MSH induces mast-cell apoptosis (cell death).

Definition of Mast Cell Activation Syndrome (MCAS)

Typical clinical symptoms as listed above
Increase in serum tryptase level or an increase in other mast cell derived mediators, such as histamine or prostaglandins (PGD2), or their urinary metabolites,
Response of symptoms to treatment

Diseases Associated with Mast Cell Activation Syndrome (MCAS)

Allergies and Asthma
Autism
Autoimmune diseases (Hashimoto’s thyroiditis, systemic lupus, multiple sclerosis, bullous pemphigoid, rheumatoid arthritis and others.                                            Eczema
Celiac Disease
Chronic Fatigue Syndrome
CIRS (chronic inflammatory response syndrome)
Eosinophilic Esophagitis
Fibromyalgia
Food Allergy and Intolerances
Gastroesophageal reflux (GERD)
Infertility (mast cells in endometrium may contribute to endometriosis)
Interstitial Cystitis
Irritable Bowel Syndrome (IBS)
Migraine Headaches
Mood disorders – anxiety, depression, and insomnia
Multiple Chemical Sensitivities
POTS (postural orthostatic hypotension)

Mast cells are known to be the primary responders in allergic reactions, orchestrating strong responses to minute amounts of allergens. Several recent observations indicate that they may also have a key role in coordinating the early phases of autoimmune diseases, particularly those involving auto-antibodies.

Lab tests specific to mast cell activation for suspected MCAS may include:

Serum tryptase (most famous mast cell mediator)
Serum chromogranin A
Plasma histamine
Plasma PGD2 (chilled)
Plasma heparin (chilled)
Urine for PGD2 (chilled)
PGF2a
N-methylhistamine

Tryptase is the most famous mast cell mediator. Serum tryptase value is usually normal in MCAS patients, but sometimes it is elevated. Tryptase values that show an increase of 20% + 2 ng/ml above the baseline level are considered diagnostic for MCAS.
Chromogranin A is a heat-stable mast cell mediator. High levels can suggest MCAS, but other sources must first be ruled out, such as heart failure, renal insufficiency, neuroendocrine tumors and proton pump inhibitor (PPI) use.
Heparin is a very sensitive and specific marker of mast cell activation. However, due to its quick metabolism in the body, it is very difficult to measure reliably.
N-methylhistamine is usually measured in a 24 hour urine test to account for the variability in release over the course of the day.
Prostaglandin D2 is produced by several other cell types, but mast cell release is responsible for the dominant amount found in the body. PGD2 is less stable than histamine and metabolized completely in 30 minutes.
Other less specific mast cell mediators that are sometimes abnormal in MCAS patients include Factor VIII, plasma free norepinephrine, tumor necrosis factor alpha, and interleukin-6.

Treatments to reduce MCAS symptoms and lower histamine

H1 Blockers – hydroxyzine, doxepine, diphenhydramine, cetirizine, loratadine, fexofenadine
H2 Blockers Famotidine (Pepcid, Pepcid AC), Cimetidine (Tagamet, Tagamet HB) Ranitidine (Zantac)
Leukotriene inhibitors: Montelukast (Singulair), Zafirlukast (Accolate)
Mast cell stabilizers -Cromolyn, Ketotifen
Tyrosine kinase inhibitors – imatinib
Natural anti-histamines and mast-cell stabilizers
Ascorbic Acid
Quercetin
Vitamin B6 (pyridoxal-5-phosphate)
Omega-3 fatty acids (fish oil, krill oil)
Alpha Lipoic Acid
N-acetylcysteine (NAC)
Methylation donors (SAMe, B12, methyl-folate, riboflavin)
Certain probiotics decrease histamine productionLactobacillus rhamnosus and bifidobacter species
DAO Enzymes with meals – Xymogen HistDAO or Histamine
Decrease consumption of high histamine foods (more on histamine-restricted diet)
Avoid alcoholic beverages
Avoid raw and cured sausage products such as salami.
Avoid processed or smoked fish products. Use freshly caught seafood instead.
Avoid pickles
Avoid citrus fruits.
Avoid chocolate
Avoid nuts
Avoid products made with yeast and yeast extracts
Avoid soy sauce and fermented soy products
Avoid black tea and instant coffee
Avoid aged cheese
Avoid spinach in large quantities
Avoid tomatoes, ketchup and tomato sauces
Avoid artificial food colorings & preservatives
Avoid certain spices: cinnamon, chili powder, cloves, anise, nutmeg, curry powder, cayenne pepper

Specific Symptom Treatment in MCAS

(Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options)

Headache⇒ paracetamol; metamizole; flupirtine
Diarrhea⇒ colestyramine; nystatin; montelukast; ondansetron
Colicky abdominal pain ⇒ metamizole; butylscopolamine
Nausea⇒ metoclopramide; dimenhydrinate; 5-HT3 receptor inhibitors; icatibant
Respiratory symptoms (mainly increased production of viscous mucus and obstruction with compulsive throat clearing) ⇒ montelukast; acute: short-acting albuterol
Gastric complaints⇒ proton pump inhibitors
Osteoporosis, bone pain⇒ biphosphonates, Vitamin D plus calcium
Non-cardiac chest pain⇒ H2-histamine receptor antagonist; proton pump inhibitors
Tachycardia⇒ verapamil; AT1-receptor antagonists; ivabradin
Neuropathies ⇒ a-lipoic acid
Interstitial cystitis⇒ pentosan, amphetamines
Sleep-onset insomnia/sleep-maintenance insomnia⇒ triazolam/oxazepam
Conjunctivitis⇒ preservative-free eye drops with glucocorticoids for brief course
Elevated prostaglandin levels, persistant flushing⇒ incremental doses of acetylsalicylic acid (50-350 mg/day; extreme caution because of the possibility to induce mast cell degranulation)

For more on MCAS, Lyme/MSIDS, and parasites:  https://madisonarealymesupportgroup.com/2017/03/23/rebecca-keith-on-mcas-parasites-lymemsids/

References

Mast Cell Activation Syndrome, A Review http://www.jillcarnahan.com/downloads/MCASReview.pdf
Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options  http://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-4-10
Presentation, Diagnosis and Management of Mast Cell Activation Syndrome by Dr. Afrin  http://www.jillcarnahan.com/downloads/MCAS-Afrin.pdf
Histamine and Gut Immune Mucosal Regulation  http://www.jillcarnahan.com/downloads/Histamine-gut.pdf
Dr. Theoharides presents “Mast Cell Disorders”  https://www.youtube.com/watch?v=92nrFwcNSwc&feature=youtu.be
Diagram of Histamine Symptoms  https://mastcellblog.files.wordpress.com/2013/11/mast-cell-symptoms.jpg
Mast Cell Aware  http://www.mastcellaware.com
A Tale of Two Syndromes  http://www.dysautonomiainternational.org/blog/wordpress/a-tale-of-two-syndromes-pots-and-mcas/
Mold Histamine Connection  https://healinghistamine.com/the-mold-histamine-link/