Dr. Bernstein:
I am Dr. Jonathan Bernstein. I'm Professor of Medicine at the University of Cincinnati College of Medicine, and I'm also a partner at Bernstein Allergy Group and Bernstein Clinical Research Center.
Graphic: What are the common dietary triggers that can impact SM?
Dr. Bernstein:
A lot of patients are avoiding foods that contain histamine, and that's still a little bit controversial in terms of its real impact on health. In fact, it can be a very restrictive diet, so I think that things should be done in moderation. These patients don't necessarily have food allergies or aren't necessarily sensitized to environmental allergens, and they aren't necessarily atopic. It's a different disease.
It's more important to avoid medications or other things that can activate mast cells. There are certain medications, such as narcotics. Opiates can activate mast cells directly. Also, there are certain foods that can activate mast cells, such as strawberries, that contain lectins, and lectins can activate mast cells.
I think that going on a strict, histamine-free diet, which is a bioactive amine, has not been really convincingly shown to be a good course of therapy. If people want to avoid foods that are very high in histamine, that's fine, as long as they're eating a balanced diet, and not getting malnourished in the process.Others have used histamine DAO supplements that block the synthesis of histamine, or break it down, I should say, and it's a carboxylase inhibitor. Again, that hasn't been shown to be necessarily beneficial either, but people do use these supplements and so forth.
Of course, there are other over-the-counter supplements such as quercetin and luteolin. These are flavonoids, and quercetin may actually have some mast cell-stabilizing properties. People have used these supplements as well. There are some data to support their use, and they are safe to use. Those are sometimes things people have used to help improve their well-being, and luteolin might actually improve fatigue in many of these patients. So there are a lot of different nuances in the management of patients, and it's not one-size-fits-all.
Graphic: What is the role diet plays in SM, and what are the general dietary restrictions or recommendations for patients?
Dr. Bernstein:
Yeah. I think that patients have to really pay attention to what they're eating. They can figure out, are there foods, for instance, that are making them feel worse? Also, they should keep a food diary to look and see what the relationship is. Of course, it's important to make sure it's an effect and not an association. Many times we make associations, and this leads to an erroneous avoidance of foods that are not necessarily problematic.
So we just have to guide them, and many times, we might refer patients to a nutritionist/dietician. But we know enough about currently – experts who take care of mastocytosis know enough about diet and what is able to be tolerated and not, and we can advise our patients accordingly.
