https://www.annallergy.org/article/S1081-1206(23)01490-4/abstract
Annals of Allergy, Asthma and Immunology, Volume 132, ISSUE 4, P411-412, April 2024. DOI: https://doi.org/10.1016/j.anai.2023.12.005
In this issue of the Annals, Theoharides et al present a thought-provoking review on an extended scope of practice for the allergist-immunologist of tomorrow. The authors highlighted that although mast cells have traditionally been compartmentalized to a narrow pathway of IgE engagement and release of a limited scope of mediators (eg, histamine and tryptase), in fact these cells are pleiotropic and active across organs systems.
Mast cell activation mediators are quite diverse and include tumor necrosis factor and mitochondrial DNA acting as an alarmin, chemokines, interleukin-6, interleukin-10, and transforming growth factor beta.
These cells have proximal and intimate neurovascular and neuroendocrine connections.
They are located throughout the body, often in critical locations including the central nervous system and coronary arteries.
In their review, the authors highlighted data that suggest mast cell engagement through environmental and food allergens, including mast cell stimulation through corticotropin-releasing hormone neuronal-mediated stress, may lead to disruption of the blood-brain barrier.
The implications of these proposed pathophysiological interactions could be both arousal and cognitive dysfunction, which may explain “brain fog” reported by some patients with mast cell activation disorders.
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