Chronic hives, mysterious allergic reactions, and unexplained symptoms? You might have Mast Cell Activation Syndrome (MCAS). Functional medicine physician Dr. Alison DiBarto Goggin shares everything you need to know about MCAS – from symptoms and diagnosis to root causes and treatment protocols that actually work.
Learn about the connection between MCAS, long COVID, POTS, EDS, and gut health. Discover why standard testing often fails, which probiotics make histamine WORSE, and how to implement effective antihistamine protocols, dietary changes, and nervous system regulation.
Dr. Alison shares her personal journey with severe MCAS after COVID and the protocols that brought her to remission – including the probiotic mistake most people make, therapeutic supplement dosing, and the brain-gut connection.
Download the FREE MCAS & Mold Illness Manual: https://alisondibartogoggin.podia.com/mcas-manual
Topics: MCAS symptoms, histamine intolerance, DAO enzymes, low histamine diet, mast cell stabilizers, long COVID, POTS, EDS, gut dysbiosis, biofilms, mold exposure, vagus nerve support, functional medicine protocols.
Disclaimer: Educational content only, not medical advice. Consult your healthcare provider.
Connect: http://www.littleblackbagmedicine.com | @AlisonDiBartoGoggin
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Transcript:
If you’ve ever felt like your body is attacking itself – breaking out in mysterious hives, reacting to foods you’ve eaten your whole life, or experiencing symptoms that doctors can’t explain – this episode is for you. I’m Dr. Alison, and today we’re talking about Mast Cell Activation Syndrome. I’m sharing both the functional medicine approach and my own journey through burning hives, dismissive doctors, and eventually, to remission.
We’re covering what MCAS actually is, why it’s so hard to diagnose, the root causes, and most importantly, what actually works for treatment. I’ll share my personal story and the protocols that helped me get into remission.
Quick reminder: this is educational content, not medical advice. You need to work with your own providers to find what’s right for you. I have a comprehensive free e-book on MCAS and mold illness available in the show notes with all the details we’re covering today.
WHAT IS MCAS & WHY IT’S SO HARD TO DIAGNOSE
Mast Cell Activation Syndrome is when your mast cells – part of your immune system that are designed to be first responders. – start overreacting and releasing chemicals like histamine when there’s no real threat. It’s like having an overly sensitive alarm system.
Normally, when you get a bug bite, your mast cells release histamine causing redness and swelling, then everything calms down. With MCAS, these cells become hypersensitive and release chemicals inappropriately, affecting your entire body.
Here’s why diagnosis is so difficult – MCAS can cause almost any symptom you can imagine:
=Chronic hives and skin reactions
=Digestive issues like IBS, reflux, stomach pain
=Heart palpitations and increased heart rate after eating
=Headaches and brain fog
=Severe PMS or PMDD
=Anxiety and insomnia
=Joint pain and fatigue
=hat runny nose every time you eat
You might have one symptom from each category or all of them. There’s no typical presentation, which is exactly why conventional medicine struggles with this.
Testing for MCAS is incredibly challenging. Blood tests for tryptase and histamine, or urine tests for methylhistamine are only elevated during an active flare – usually within the first hour of symptoms.
Think about the logistics: you wake up at 3am covered in hives. Are you making it to a lab within an hour? By the time you get there and wait, that window has closed. The test comes back normal, but you’re still suffering. This is why I diagnose based on clinical presentation, symptom patterns, and response to treatment. I use functional testing to identify root causes – comprehensive stool analysis, organic acid testing, food sensitivity testing – rather than trying to catch a flare.MCAS is also closely associated with POTS, Ehlers-Danlos Syndrome, autoimmune conditions, and long COVID. It’s on the rise because viral infections, especially COVID, can trigger chronic mast cell activation.
MY PERSONAL STORY
Eight days after my COVID infection, I woke up covered head to toe in excruciating, burning hives. I had dermatographism so bad that the lightest touch left red welts across my skin. The hives formed along old surgical sites and injuries. My symptoms included constant hives, severe headaches, joint pain, digestive disruption, and eventually POTS and crushing fatigue.
I saw a functional medicine doctor who gave me compounded medications and supplements that didn’t help. When I came back still suffering, he said, ‘I don’t know what else you want me to do for you.’
The next doctor helped reduce my symptoms by half which was amazing and wonderful and referred me to an immunologist. When I described my symptoms, he told me I was basically lying or exaggerating. I showed him pictures – covered in hives – and he said I’d just scratched myself. Then he admitted this condition was so new and poorly understood that no one in immunology knew what to do. His advice? Double my medications and come back in six months. I combined the best of all worlds: I kept one prescription that helped, added one over-the-counter medication, and used herbal antihistamines at therapeutic doses – not the baseline doses on the bottle. I tripled my typical doses and took them religiously every day.
I used DAO enzymes, specific histamine-degrading probiotics, high doses of B vitamins, doTERRA’s Tri-Ease at 2 per day, and eventually nicotine patches to clear the viral load. We will talk more about protocols in a few minutes. It took months, but I got into remission. Now I have a built-in warning system – if I start getting hives, I know I’m coming down with something. It’s manageable, and I know exactly how to support my body.
ROOT CAUSES – THE BIG PICTURE
There is no one root cause of MCAS. Everyone’s journey is different. Here are the common patterns:
Viral Activation – This is what happened to me. COVID, Epstein-Barr, CMV, and other viruses can trigger hyper-inflammatory pathways that never fully calm down. Research shows 24-50% of COVID patients develop long-haul symptoms.
Autoimmunity – Pre-existing conditions like IBD, Hashimoto’s, or lupus create immune dysregulation that primes mast cells to overreact.
Gut Dysfunction – Dysbiosis, leaky gut, SIBO, and candida overgrowth directly trigger mast cell activation. Specific gut bacteria either produce histamine or break it down. When you have overgrowth of histamine-producing bacteria, you’re in trouble.
Chronic Infections and Biofilms – Hidden parasites like Blastocystis, bacterial overgrowths protected by biofilms, and fungal colonization continuously trigger your immune system.
Mold Exposure – Mold spores and mycotoxins directly irritate mast cells, overwhelm detox pathways, and can colonize in your gut and sinuses.
Genetics – Variants affecting detoxification (MTHFR), histamine breakdown (DAO deficiency), and immune regulation make some people more susceptible.
Hormonal Imbalances – Estrogen increases mast cell sensitivity. This is why symptoms can worsen during certain times of your cycle.
Chronic Stress – Stress impairs vagus nerve function, increases gut permeability, and directly activates mast cells through the brain-gut connection.
These don’t exist in isolation. You might have viral reactivation that damaged your gut, leading to dysbiosis, which increased inflammation, which triggered genetic vulnerabilities, creating more mast cell activation. We need to address multiple pieces.
TREATMENT PROTOCOLS THAT WORK
The most effective treatment combines conventional medicine, functional medicine, and lifestyle changes. Here’s what actually works:
Phase 1: Immediate Symptom Relief
Over-the-counter options:H1 blockers like cetirizine (Zyrtec) or loratadine (Claritin)H2 blockers like famotidine (Pepcid) – blocks histamine in the stomach
Diphenhydramine (Benadryl) for acute flares
The combination of H1 and H2 blockers works better than either alone
DAO Enzymes:Take before meals to break down histamine from food
Critical for reducing food-related reactionsMust be taken consistently with every meal
The Probiotic Mistake Most People Make:
This is huge – some probiotics PRODUCE histamine and will make you worse.
Avoid these strains:
-Lactobacillus casei
-Lactobacillus bulgaricus
-Lactobacillus fermentum
Fermented foods like kombucha, kefir, sauerkraut
Use these histamine-degrading strains:
-Bifidobacterium longum
-Bifidobacterium infantis
-Lactobacillus rhamnosus GG
-Lactobacillus plantarum
This is why you might have tried probiotics and felt worse – you were taking the wrong strains.
B Vitamin Support:
Essential for methylation pathways that break down histamine
Support DAO enzyme function
People with MTHFR variants need methylated forms
Use therapeutic doses, not just baseline recommendations
Herbal Support – Therapeutic Dosing:
This is where most people miss the mark. The dose on the bottle is for mild, acute symptoms. For moderate to severe MCAS, you need therapeutic doses.
I took doTERRA’s Tri-Ease at 2 per day, and tripled my other herbal antihistamines. You need to find YOUR therapeutic dose and maintain it consistently.
Phase 2: Address Root Causes
Gut Healing: Repair the gut lining with L-glutamine, zinc carnosine, aloe and Butyrate supplementation to reduce inflammation
Address dysbiosis with targeted antimicrobials
Use binders like activated charcoal or GI Detox to remove toxins
Biofilm Protocol: If you have chronic infections or mold colonization, you need to break down biofilm carefully.
I recommend pulsing:7 days of biofilm disruptors and antimicrobials7 days of gut healing and probiotic support
RepeatThis prevents overwhelming your system when biofilm breaks apart and releases organisms.
Liver and Detox Support: Glutathione – the master antioxidant
NAC for glutathione production and mucus breakdown
B vitamins for detox pathways
Milk thistle, dandelion root for liver support
Phase 3: Nervous System Regulation – The Missing Piece
Your nervous system state directly influences mast cell activity. Chronic stress keeps mast cells hyperreactive even when you’re doing everything else right.
Vagus nerve support:
-Deep diaphragmatic breathing
-Gargling water vigorously
-Humming or singing
-Gentle movement like restorative yoga
-Brain retraining programs: DNRS, Gupta Program, Train the Brain
These aren’t woo-woo – they’re evidence-based approaches to calming limbic system overactivation
Phase 4: Diet – With Nuance
There’s no one perfect anti-histamine diet. You need to personalize based on YOUR reactions.
General principles:
-Avoid leftovers – histamine increases as food sits
-Avoid deli meats, aged cheeses, cured meats
-Be cautious with fermented foods
-Consider limiting nightshades
-Avoid alcohol and limit coffee
Focus on:
-Fresh, whole foods
-Cook and eat within 24 hours
-Low-histamine proteins like fresh chicken, lamb, fish
-Low-sugar fruits like berries
-Most vegetables
-Healthy fats
But use food sensitivity testing to identify YOUR triggers. Your body is unique.
Phase 5: Environmental Factors
Use fragrance-free products everywhere
Address mold exposure – test your home if needed
HEPA air filters in bedroom and living areas
Avoid chemical exposures
Manage temperature – many MCAS patients are heat-sensitive
Advanced Options When Needed:
Nicotine patches – Emerging research for viral elimination and neuroinflammation in long COVID cases. Only under medical supervision.
IV nutrient therapy – High-dose vitamin C, Myers’ Cocktail, glutathione IVs when oral supplementation isn’t enough.
Prescription medications – Mast cell stabilizers, leukotriene inhibitors, low-dose naltrexone, antifungals. Work with a knowledgeable provider.
REALISTIC EXPECTATIONS & FINAL TAKEAWAYS
Let me be honest about expectations. Most people see:
Initial symptom reduction within 2-4 weeks
Significant improvement within 2-3 months
Full remission or stable management within 6-12 months
But this requires addressing root causes, not just masking symptoms.
MCAS management requires daily consistency, especially in the beginning. Take supplements at therapeutic doses every day, maintain dietary changes, continue gut healing even when you feel better, and keep up nervous system practices.
If you’ve been following a protocol for 2-3 months without ANY improvement, something needs to change. You might be missing a root cause, your doses might not be therapeutic, you could be taking the wrong probiotics, or you might need prescription support.
Key Takeaways:
You’re not making this up. MCAS is real, and testing limitations don’t invalidate your experience. There’s no single root cause. This requires individualized investigation. Treatment is multifaceted – you need symptom relief, root cause work, nervous system regulation, and environmental changes all together.
Therapeutic dosing matters. The bottle dose might not be enough for moderate to severe MCAS. Consistency is everything. Commit to your protocol for at least 2-3 months.
You deserve a doctor who listens. If your provider dismisses you, find someone else.
Download my free MCAS and mold illness e-book at littleblackbagmedicine.com – it includes detailed protocols, supplement recommendations, testing options, and dietary guidelines.
If you want to work together, I offer virtual consultations, in-person intensives, group programs, and affordable lab testing. Everything is at littleblackbagmedicine.com or find me on Instagram @alisondibartogogginI know how isolating this journey is. I’ve been there – covered in hives, dismissed by doctors, desperately searching for answers. But healing is possible.
If this episode resonated, share it with someone who needs to hear it. Tag me on Facebook or Insta- I love hearing your stories.