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Animal usage and experimentation were approved by the Institutional Animal Care and Use Committee at the University of Miami and were in accordance with the US Public Health Services Policy on Humane Care and Use of Laboratory Animals

There may also be a genetic susceptibility at work, and depression and anxiety are common in people with the syndrome

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MCAS patients may have a few key symptoms that are not typical in histamine intolerance 44 : 76% of people with MCAS have skin dermatographia, developing red marks lasting over 30 minutes after a light scratch on their skin Abnormal blood clotting or bleeding/bruising without other identifiable causes Strange food and medication reactions Symptoms may be severe and spontaneous, without provocation The American Academy of Allergy, Asthma & Immunology recommends the following blood tests to diagnose MCAS 45 : Serum mast cells tryptase, which is a marker of excessive mast cell activation 46 Normal 50 ng/mL Skin and bone marrow biopsies for increased mast cells

The authors thank Thomas Eissenberg, PhD, for his input on this manuscript and Pamela Borek for administrative assistance.