Do I Have Mast Cell Activation Syndrome (MCAS)?
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Do I Have Mast Cell Activation Syndrome (MCAS)?
After years of worsening allergic reactions, it finally dawned on me: do I have Mast Cell Activation Syndrome?
I was fourteen at volleyball camp when my pelvis started to itch. I couldn’t focus on the game. The itching became violent. I ran to the bathroom and locked myself in a stall.
I was wearing new volleyball shorts with built-in underwear, and I wondered if the new shorts were somehow causing an allergic reaction, so I pulled them down to my ankles, but the rash only spread to my thighs and turned into hives. Soon my forearms were on fire and splotchy, and my tongue felt huge. I noticed a tingly sensation in my throat and that it felt tight, and so did my eyelids, and everything burned. No matter how hard I itched my skin or scratched my tongue with my teeth, nothing brought any relief.
I pulled my shorts up and ran to the bathroom mirror. My lips were three sizes too big. My vision was blurry, and my eyelids were starting to swell. My face was not my face. My skin was like a red balloon. I hadn’t eaten anything except pistachios. But that wasn’t new. I ate pistachios every day. I didn’t know what was happening.
I stumbled out of the bathroom and onto the court. I walked out, embarrassed, trying not to disturb the game.
“Coach,” I said, tapping her shoulder. “I think I’m having some sort of reaction—”
“Oh my god, your face!” someone shouted from the court.
Everyone stopped playing. Fifty girls were staring at me. When the coach turned around and saw me, she gasped.
That’s when I threw up everywhere. I felt myself falling. Everything went black.
When I regained consciousness, I was in a wheelchair with an IV in my arm and hardly able to breathe. I remember clutching my throat. It was closing. I could barely swallow. I couldn’t see because my eyes had swelled shut.
“My baby, my baby!” I heard my mom cry. “Save my baby!”
Shit, I remember thinking. Mom stop embarrassing me, but my eyes were swollen shut so she couldn’t see me rolling them.
Anaphylaxis and red-ants
That was my first episode of anaphylaxis. At first, I thought it was an isolated event. I thought I was allergic to pistachios, and that’s it. But it happened again at seventeen, this time to red ant bites.
I was at a football game in Florida my senior year of high school when six ants bit me on the ankle. I didn’t have my epi-pen. I didn’t know I was allergic to ants back then.
That one was a close call; I almost didn’t make it to the hospital in time. I was at boarding school that year, and my friend’s dad drove me to the ER, but no one was taking my allergies seriously. In the car, on the way to the hospital, my friend’s dad asked, “Do you mind if we stop for take-out real quick?” They pulled into a McDonald’s before I could say no. My throat was starting to swell.
The third time was a weird one: anaphylaxis-induced exercise. I was jogging outside the summer I was eighteen, and all of a sudden, the symptoms began again. I ran home as fast as I could. I wasn’t sure if I’d make it. Everything itched. I scratched my arms and legs as I sprinted the half-mile home. By the time I ran down the hill through the woods to our house, my face and body was covered in hives, and my tongue was on fire. My mom gave me six Benadryl and drove me to the hospital. After that, no more cardio.
Slowly, over a period of six or seven years, the reactions have grown more severe.
Now I’m twenty-three, and the list of things my body rejects includes bee stings, gluten, peanuts, pistachios, cashews, mushrooms, rice, corn, potatoes, grass, dairy, soy, coconut, tomatoes, vinegar, all spices, all preservatives, artificial dyes, seafood, beans, almonds, dogs, cats, dust mites, apples, bananas… the list goes on.
I’m a senior at UNC-Chapel Hill. For breakfast, I eat blueberries. For lunch, I have plain chicken on plain lettuce with some cucumbers or carrots. For dinner, I eat more chicken. Dessert is dried mangos; well, until my last month (I had an anaphylactic reaction, so no more dried fruit for me!) Also, no more meat. So I can eat four foods now: blueberries, cucumbers, carrots, and chicken.
I can’t keep on weight. That’s a problem. It’s hard to gain weight on the foods I can eat. Sometimes I itch for no good reason. I have gone into spontaneous anaphylaxis. Yes, this is a real thing. You can have a life-threatening reaction to nothing at all.
I never know if I’ll end up in the hospital. I take Benadryl and Zantac, and Zyrtec every day just in case. The good thing is that if I become allergic to all foods, I could still survive with a feeding tube.
I’ve been to allergists, cardiologists, and internal medicine doctors. I’ve had many skin-prick and blood tests heard theories about gluten and GMOs. I have received no conclusive answers. The best they can give me is, “Always carry your epi-pen.”
Read more: Kissing someone with allergies can be lethal
Anaphylaxis and steak
Three months ago, in April, it happened again. It was a Friday night. I ate steak at 8 pm. By 9 o’clock, I was doubled over in pain and itching everywhere. I took four Benadryl. The stomach pain felt like I was having appendicitis. I broke out in cold sweats, then came extreme nausea. I ran to the bathroom. I couldn’t stand up straight. I called my boyfriend, Adam. “Something’s not right,” I said.
Adam was downtown drunk on a party bus. “Do you need me?” he asked. “Should I stop the driver and come to you?”
“No,” I told him.
“I don’t know.” I hung up the phone and dialed my mom. By that point, I was itchy all over, and my throat felt tight.
“Madi?” my mom said.
“What’s up?” I said again, “Something’s not right.”
“Madi, what is it? Are you having a reaction?”
The pain in my lower abdomen felt like an organ had burst. I could hardly talk.
“Madi,” she said, “Do you have your epi-pen?”
I felt like I was going to fall over. There was a thick layer of sweat coating my skin. “I’ll call you back,” I said to my mom, because I was beginning to worry that my epi-pens were expired. But before I could find one, I had to call Adam. Sitting at the toilet, gagging, lightheaded, and nauseous, I called Adam again.
“I’m itchy,” I said. “I need help.”
“What’s happening?” asked Adam. “Should I call 9-11?”
But I couldn’t talk. My insides were rumbling, and I felt intense lower abdominal pain. I could tell I was about to vomit. “I’m getting off the bus,” Adam said. “I’m coming to you.”
But I couldn’t respond. I had to put the phone down on the floor. Something bad was about to happen. There was an impending feeling of doom that I get during all of my reactions. I thought something’s not right. Quickly I sat on the toilet. I picked up the trash can. That’s when I had explosive diarrhea and projectile vomiting at the same time. Adam stayed on the line.
Meanwhile, I was also losing consciousness, itching, and dripping in sweat. It looked like I’d just jumped into a pool with my clothes on. Once I stopped puking and could talk again, barely conscious, I said to the phone, “Adam, I’m not okay. Call 9-11.”
And he did. We hung up. A minute or so later, I received a call from the police. “Can you verify your name and date of birth?” I almost laughed. I could hardly speak.
“Send someone,” I said. “About–pass out–“
“An ambulance is en route,” the dispatch woman said. “Madison, can you tell me, is the door to your house unlocked?”
“No,” I said.
“Listen,” she said, “I need you to go unlock the front door now so the paramedics can come in.”
And I said, “I don’t think– can’t move–“
“Ma’am. You need to unlock the front door now, or the paramedics won’t be able to help you.”
I was naked on the floor, covered in vomit, sweat, and my own shit. There was a bathrobe a few feet away. I reached for it and covered myself. This won’t last forever; I kept thinking. You feel bad now, but this won’t last forever. You’ll survive, or you’ll die. This won’t last forever. And this thought reassured me.
I was able to get up and unlock the door. It took all my concentration to stand up. Stand, I thought. Walk. My vision went black. Two steps. Four. I remember the phone was too heavy to hold. I kept dropping it. I could barely walk the abdominal pain was so bad.
I made it into the hallway. I stumbled to the front door. I unlocked it. “Now,” the dispatcher said, “Is anyone else in the house with you?”
I said, “Dunno.”
She said, “Go look.”
I walked back through the hallway. Cori’s bedroom light was off, but Riley’s was on. “Riley!” I tried to yell. It sounded like a slight moan. I was embarrassed by the way I smelled, but I knew that I needed help.
“Riley!” I said again. I banged on her door.
“Yeah?” she said, opening up.
“Need–help,” I said, slurring my words. I handed her the phone and struggled to close my bathrobe.
“Hello?” Riley said into the phone. “Okay. Yes. She’s still conscious. Madison?” Riley said, “where do you keep your epi-pens?”
I pointed to my dresser inside my bedroom.
“Have you used one before?” Riley asked, picking up the yellow box and opening the tester. I shook my head. “Do you want me to do it?” she said, “or can you?”
And I said, “Me,” because I was half-naked, and I hadn’t had time to clean up yet and didn’t want her to see me like that.
I practiced with the tester. It took more force than I’d expected. The first time I swung the tester against my thigh, it didn’t click because I didn’t do it hard enough. I practiced again with the tester, and this time I used enough pressure. It made a click. Then I picked up the real thing and jammed it into my thigh.
By the time the paramedics arrived fifteen minutes later, I looked much better, and I wasn’t itching anymore. The epi overwhelmed my system, causing uncontrollable shakes. My legs were bouncing all over the place.
Adam arrived at the same time as the paramedics. He was drunk and rubbing my back as I cried on the bed. He joked, “You know; if you wanted to see me that bad, you only had to ask.” I laughed, and the paramedics asked why a girl my age had so many medicines. I rattled off a few of my allergies. Adam said, “It’s easier for her to say what she’s not allergic to.” He kissed me on the cheek and rode with me in the ambulance.
Do I Have Mast Cell Activation Syndrome?
Sarah calls it M-CAS on the phone. I don’t like the acronym. It sounds cute or casual. I prefer the full name: Mast Cell Activation Syndrome.
My mom met Sarah’s mom at church one day. It was a chance encounter. They began talking, and Sarah shares all my symptoms. She’s been to the ER sixty times in the past year.
“I can be walking through a parking lot,” Sarah says, “smell cigarette smoke, and go into anaphylaxis right there on the street.”
Sarah has MCAS. It’s a rare disease that basically means you’re allergic to everything. In other words, in MCAS patients, mast cells release too much histamine. And the mast cells release histamine when they’re not supposed to. It turns out I have MCAS too. It’s a new diagnosis, added in 2007, and most doctors don’t know about it. Half of the doctors that do know about it don’t believe it’s a real thing. Like how people would scoff at Fibromyalgia or Irritable Bowel Syndrome before these diagnoses were accepted as a real thing. As you might expect, this makes receiving treatment difficult and living with MCAS invalidating. After listening to Sarah I repeatedly asked her and myself, ‘do I have Mast Cell Activation Syndrome?’
On average, it takes people with MCAS ten years to be diagnosed. After a decade of searching for answers, Sarah finally refers me to her Mast Cell Specialist. He talks to me for an hour. He says he’s seen a hundred women like me. I’m twenty-three, and it’s almost been ten years since my first reaction at volleyball camp when I was fourteen.
Soon I’ll add new medicines. There’s no set regimen; the doctor says because very little research has been done on this disease. You can find a support group, he says, and it’s a good thing you met Sarah. There are clinical trials to sign up for and injections to try. Keep carrying your epi-pen.
Now I have at least thirty of them.
After my Mast Cell Activation Syndrome diagnosis
Sarah texts me from the ER. She had a chipmunk bite and needs rabies vaccines, and it turns out she’s allergic to the vaccines. She requires four of them. I’m in the ER, too because of ant bites. We joke about the hospital being our second home. It’s only funny because it makes us feel better.
She recommends Epsom salt baths. “You can add lavender,” she says, “But some people react to that,” I say,
“Knowing my body; I’ll play it safe.” Sarah laughs.
“‘Knowing my body,'” she says. “That’s something I always say.”
Madison Welborne is an advocate for people with physical and mental illnesses who has been published in The Emerson Review, Herstry.com, Memoir Magazine, and UNC’s Health Humanities Journal.