Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity by Lawrence B. Afrin M.D. & Kendra Neilsen Myles

Author:Lawrence B. Afrin M.D. & Kendra Neilsen Myles [Afrin M.D., Lawrence B.]
Language: eng
Format: epub
Publisher: Sisters Media, LLC
Published: 2016-03-14T07:00:00+00:00

Finally, these criteria require treating the patient for the disease (before the disease has been diagnosed) and observing at least some improvement. Not only is this a “Catch-22” that’s at odds with the general principle of diagnosing before treating, but it’s also at odds with the observed marked heterogeneity of the clinical behavior of MCAS (which, as you know by now, I strongly suspect is due to underlying marked mutational heterogeneity), in which some patients benefit little from the first few or several MC-targeting therapies tried. It would seem that if the patient demonstrates clinical and laboratory evidence of mast cell activation and has no other identifiable illness that can better account for the full range of findings in the case, it would be premature to reject the diagnosis if the patient fails to respond to merely a few lines of therapy. (To be sure, as the patient fails to respond to each successive line of MCAS-directed therapy, it is imperative that the doctor reconsider what other diagnostic possibilities might be appropriate in the patient, a process that may involve yet more hours of history-taking or literature-searching, but if the sum total of symptoms and findings continue to argue more strongly for mast cell disease than other disease, then additional trials of MCAS-directed therapy may well be warranted given the possibility that that patient might “simply” have a variant of MCAS that’s resistant to the types of medications commonly tried early on in treating MCAS.)

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