Mast Cell

Mast Cell Activation

Mast Cell Activation Syndrome

Treatment

MCAS Innovations: New Paths In Diagnosis & Treatment

Reversing Mast Cell Activation and Histamine Intolerance Summit 2.0

https://drive.google.com/file/d/1hCzYcnGpVjzB_xGxaIkOp7vqlu6KZ8ch/view?usp=drive_link

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">Thank you so much for having you, Meg. I'm so excited to connect and to connect with the community.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Yes. It's much needed. We need to get more information out there.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">Absolutely.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Before we were going to get into some great things today. But before we do, can you just give us a little bit of your background and how you got to be an expert in mast cells?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">I am not only a board-certified allergy immunology and lifestyle medicine physician, but I'm also an invisible illness and autoimmune patient, and I honestly didn't specialize in mast cell disorders on my bingo card when I finished training, I thought that they were particularly interesting, and I had a mentor along the way who was very involved in some basic science research and headed the mast cell committee at the end of her career. Taking care of these conditions was a bit daunting because mast cells are not as well understood in many respects compared to other things that are bread and butter in allergy immunology, like runny noses, itchy, watery eyes, and asthma. But it was my experiences shortly after finishing my training with my health that had me recalibrating and connecting deeply with this population of individuals who were coming to see me, especially at the Academic Center in our region, having all of these stories of their lived experiences not being heard and not being taken seriously. It was out of that and feeling and connecting deeply with that that I then shifted my focus, clinically being able to see more of these folks and help them get their health back on track and realizing that it was going to take a very holistic approach to do so.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">That's great. Before we get into your approach and how you're working with people with MCAS, I would love to talk a little bit about the difficulty in diagnosis and figuring out and the recognition of this, because that's even the first step. A lot of people are being told that you're fine, or that this is a mystery and we don't know what's going on, and it can make you feel overwhelmed and not know what to do. But we do have diagnostic criteria. if we could get a little bit into that.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">What I typically will talk with patients about is, first of all, getting a thorough history. That's a huge part of our diagnostic skill set. One of the first things we learn as medical students and trainees is to get a thorough history and do a good physical examination because 80 to 85% of our diagnoses come from that part of the visit. That's why it's important to make sure we have enough time to spend with patients. Because of these symptoms, if you dig in, there's a lot that's been going on for quite some time.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">I know. That's an issue because sometimes you're not given the time. You have to make that time. </span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">It's absolutely. We are working, and it's not perfect that we've worked with our team and are making adjustments to our call center. I'm still working at a university. I have to bob and weave with what they have, and ensuring that I have those patients in the appropriate spots in my schedule so we aren't rushed is ideal. So, as I'm meeting people, I'm saying, be upfront. I want to know if this is what you want to talk about so that we have ample time. And then, as I'm thinking about that diagnostic process, some of the first things we're going to do are check a blood test, taste level, and also usually check urine markers for signs or symptoms of too many mast cells, misbehaving mast cells, and these mediators that these little cells release when they're triggered. I want people, I say, they very well may be normal, and that is just helping us go down one, a little bit differently. It's like choosing your adventure story from when you were growing up. We're just going to go down this path as opposed to the other path. When I see a normal tryptase, this is much less likely to be Mastocytosis or bone marrow-type issues. and it's less likely to be a hereditary alpha-tryptasemia. This genetic quirk means that about 6% of the population has extra copies of the tryptase gene. So they're walking around with elevated levels that, on their own, could be their bag of worms. Not everyone is symptomatic, but a portion is,  and this just helps us frame as to what category and what approach are we going to take. I also warn people that we are likely going to be repeating these tests, getting one that's a baseline and then making sure you're able to get these tests repeated when you're having a flare-up of symptoms as well.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">That's important. Thank you so much. Now you're using an innovative approach and immunotherapy. Can you talk to us a little bit about that?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">When we think about these little mast cells, they're these white blood cells that we consider allergy cells in part because one of the receptors that lie on their surface is an IgE antibody. Now we think about mast cells and mast cell disorders. Not all of the receptors on these cells are antibodies or allergic proteins. There are dozens of others. That's where taking a holistic approach is important because we need to think of all the ways we can calm down their hyperreactive. We know a lot about these allergic proteins or these allergic antibodies. One way we've been treating allergies for well over a century is by desensitizing our bodies to these particular substances that we have proteins for. That's what allergy shots have been, or the tablets, solutions, or shots that go under the tongue. Sublingual immunotherapy. The problem has been that these methods are time-consuming. They take three to five years. For shots, you're going into the office usually initially weekly, as you're building up eventually monthly, and with traditional shots, one and 200 people are having systemic reactions or anaphylactic type reactions. It's a significant risk. And for my patients who have mast cells that are already stirred up, they're already misbehaving. This hasn't been a solution that we have felt comfortable with. When we're talking in the office, the shared decision-making approach means someone's already reacting to the little everyday things. The idea of purposely subjecting themselves to this weekly grind sounds like a terrible idea. Like that lived experience. But also, I am not a super risk-taker. You're not going to see me jumping out of an airplane or suggesting the equivalent to my patients. First and foremost, when I initially started my practice, one of my areas of interest in my niche was providing sublingual immunotherapy; which is allergy drops. For some folks, these are better tolerated. The advantage is that you can take them home because the risk of a whole-body reaction is lower. But there are still drawbacks. There are still some of those people who are more sensitive and who are having too many issues with itching in their mouth, irritation in their throat, or maybe heartburn developing from this treatment. Again, these are taking place day in and day out for three to five years. It's a significant time commitment as we think about treatments. We're going to get in a time machine and go back to over ten years ago, when I was about to embark on my allergy immunology training, and I had this opportunity to go see a visiting professor give a talk at our local children's hospital. Our programs are linked. This researcher from Switzerland came over, and he talked about this body of research he had been working on for well over ten years that took allergens, harnessed some of the technology and science we understood from vaccinations, and used that to help treat allergies. So what they were doing was injecting a much smaller amount of allergen, like 1/100 of what we would use in a typical allergy shot in the arm, directly into the lymph node. In doing so, what they realized is that there are much fewer mast cells in the lymph nodes. They saw a marked decrease in the potential for systemic or anaphylactic-type reactions. They also saw that by delivering that allergen directly to the factory, desensitization or an immune system change occurs, where the body goes from seeing that pollen, dust mite, or pet dander as the enemy to ignoring it. That all occurs in the lymph node. It's where there's speed dating going on between our B cells and T cells, among other things. By delivering it directly there, they were able to get the same type of results they were seeing in allergy shots and allergy jobs over three to five years in just three sessions at four weeks and eight weeks. Not only was it less allergen, it was a lot fewer of his hits,  from dozens and dozens, maybe hundreds. in the case of a long course of allergy shots, down to three. It's not particularly painful. It's a very small needle. and with less reaction risk. This is a treatment that I'm excited about, and now that it is becoming increasingly available, it's still considered an emerging therapy. It's a little bit out of the experimental range and is emerging. Some colleagues have been working on teaching other healthcare professionals how to use this technique. One of my mentors, through my training and my practice, has been using it regularly in her practice for several years now and has seen remarkable and durable results. decreased reactivity not only for our patients with seasonal allergies and asthma and those sorts of things but also for her patients who were coming to see her who had more systemic itchy rashes and were feeling unwell. I don't think this treatment will be perfect for every patient with MCAS. No, it's for those who have allergies. I, and especially those who realize that their allergies are increasing the volume of their other symptoms. So if we're able to decrease the overall reaction overactivity to these things we are exposed to day in and day out or for weeks at a time during pollen seasons, I'm hopeful that this is going to be a new path, and a great tool to have in our toolbox is what we're thinking about—innovative ways, but also ways that are tackling this issue—closer to the root of what's going on.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">I love that. There are so many things and so many questions that, well, first of all, for being someone who spent years on allergy shots, the actual not having to go for years and years and getting this shot in your arm and, three sessions is like, I wish I would have met you 21 more than 20 years ago or 30 years ago. That's great. That saving that to that time and like the discomfort and the reaction to and all of the things. That is wonderful to hear. Now, I guess one of the first questions I have is: What lymph node do you detect?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">We use a little portable ultrasound device that hooks up to a nice little iPad. We use that to detect lymph nodes that are just under the surface of the skin in our inguinal area. For those who don't know, that is the area right by our bikini line, and we can find there are a couple of blood vessels on the inner part of that where the leg meets the body. We find those, and then we move far away from them. and then those lymph nodes look like a little raisin or a little pea just under the surface of the skin. So it's very similar in regards to reported symptoms of discomfort or pain to an allergy shot, if not even less because you don't get as much of that redness and inflammation as you would with a bee sting with a traditional allergy shot.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">That's great. For this type of therapy, you'd do allergy testing. This isn't a general mast cell activation treatment. It's more like, we know that allergies are one of the things that stimulate your mast cells to release. We're going to treat your allergies to bring that element down.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">I see this as a tool in this overall holistic approach and thinking about how we are going to help the microbiome and our digestion, how we are going to stabilize the mast cells, and how we are going to work on our brain, body, and nervous system input. This is just one other tool that we have, especially for that portion of patients who do have true allergies, to turn down the factors that stimulate the growth and activity of these cells. Often, when we think about allergy testing, people are going to think about those scratchy tests. and they're great. I use them every day in the office. But if I have someone with mast cell disorders and they're on a regimen of antihistamines and they're doing quite well, I am very reluctant to have them stop those medications for the least that would be required to do the skin testing. So we're very fortunate that we live in a time now where blood testing, looking for those allergy proteins or those IgE antibodies, is helpful as well. So, as we think about innovations and things moving forward, it's helpful that we're able to minimize the discomfort and flare-up of symptoms during this process as well.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">That's great. When you're saying you do three sessions, does that last long-term? Then are you seeing long-term results and immunity staying?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">We're seeing results that are, in studies, durable three to five years out. And when you look at the studies for immunotherapy, typically those are about as long as you're going to see studies for because it's so expensive to keep following people for that long. But in talking with those pioneers in the field, they are continuing to follow up with those patients who are having good results in the long term.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">That's great. Thank you. This is why I find it fascinating.  I love finding all of the reasons why the mast cells become activated. Taking each part of the puzzle and looking at it and saying, What are we going to like? You're saying we need to fix the microbiome; we need to do all of those things and clean up our environment. But one of the things I see people even saying is that these are hard things in life where people know, I'm allergic to my dog, but my dog sleeps right beside me, that your dog shouldn't sleep in bed with you, but you love your dog. What do you do in the morning?  These are real-life situations that some people run into. It's like, we need if you're sensitizing to, to eliminate; we're trying to do all the elimination. But people are dealing with these allergies all the time too.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">I laugh because there certainly were, for many decades, allergists telling families to get rid of their pets. I would like to think that pretty uniformly now, my colleagues and I are embracing the fact that Hutch adds so much richness to our lives. and for our little ones, the presence of pets in the home may help prevent allergies in some instances. So if we can help people maintain those relationships with their fur children, then I'm all for it.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Yes. Do you have anything else you'd like to share? Any other new emerging data that can help?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">It's important to just hold on to hope. There is so much that is being looked into. We're recording this just a few weeks after I returned from our National Allergy Academy of Allergy, Asthma, and Immunology meeting, and so much emphasis was placed on research surrounding mast cells looking at the interface between our immune system and our nervous system and how those are communicating with one another. We are on the brink of significant forward momentum in this field. I just want to say that there is hope. We are working on all of we mentioned those all the different receptors. There are a lot of treatments aimed at these various receptors that are in the works as well.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Thank you so much. This has been so enlightening and helpful. Could you share with everyone where they can find you?</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">I clinically practice at Ohio State University. If folks are interested in setting up a consultation for intra-lymphatic immunotherapy, the best place or the best way to do that is to call our office. We're on Eastern Standard Time at (614) 366-7297. If you want to just learn and connect with me in general, I have my website at drkarawada.com.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Thank you so much for joining us today, Kara.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">Thank you so much. This is then wonderful.</span>

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<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">It's a pleasure talking with you. Have a great day.</span>

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<h6><b>Kara Wada, MD</b></h6>
<span style="font-weight: 400;">You too.</span>

<h6><b>Meg Mill, PharmD, AFMCP</b></h6>
<span style="font-weight: 400;">Hello and welcome back to our Reversing Mast Cell Activation Syndrome And Histamine Intolerance Summit. I'm your host, Dr. Meg Mill. Today I'm joined by Dr. Kara Wada. Dr. Wada is a four-time board-certified pediatric and adult allergy, immunology, and lifestyle medicine physician. She's also an assistant clinical professor at Ohio State University, providing holistic, trauma-informed, and evidence-based care for allergies, asthma, and mast cell disorders. She's going to talk to us today about a new immunotherapy that she's seeing a lot of success with. I am so excited to dive into this and get started. Thank you so much for joining us today, Kara.</span>

https://d1tnc8rqovg0h0.cloudfront.net/2024+Summits/2024+Reversing+Mast+Cell+Activation+Summit+/Transcripts/2024_RMCAHIS_Kara+Wada%2C+MD+Transcript+File.pdf

<p>Dr. Kara Wada is a 4x board-certified pediatric and adult allergy, immunology &amp; lifestyle medicine physician, Sjogren&#8217;s patient, certified life coach, and TEDx speaker. She is an Assistant Clinical Professor at The Ohio State University providing holistic, trauma-informed &amp; evidence-based care for allergies, asthma &amp; mast cell disorders. It&#8217;s because of everything she learned and went through as an autoimmune patient that she has made it her mission to use the privilege she has as a physician to help us all navigate our health and wellness more effectively and efficiently. Most importantly, to find ways to ensure that we are fully seen and cared for as patients and as people. She helps those struggling with misbehaving immune systems Become Immune Confident through her podcast by the same name.</p>


Kara Wada, MD

<p>Dr. Meg Mill is a Functional Medicine Practitioner, PharmD, bestselling author, speaker, and podcast host. She was first introduced to Functional Medicine as a patient. She struggled with many of the issues the people she works with struggle with today. She has made it her mission to help people all around the world with her virtual practice. She works with people worldwide to heal the root cause of seemingly unrelated health struggles through advanced diagnostic testing and personalized support. With her two decades of clinical experience in conventional and functional medicine her practice is designed to look at all factors surrounding health conditions including genetic, epigenetic, biochemical, emotional, and environmental.</p>
<p>She has been seen in national publications and on media such as Fox News Channel, ABC, NBC, CBS, CNN, Reader’s Digest, Health Magazine, Mind Body Green, Authority Magazine, Life &amp; Style and Sunset Magazine as well as several national publications, blogs and podcast guest appearances.</p>
<p>After helping hundreds of patients transform their health and resolve gut health issues, hormonal imbalances, allergies, skin conditions, migraines and mood imbalances. Dr. Mill has pioneered solutions for the missing link to resolving many of these chronic health conditions by reversing Histamine Intolerance and MCAS with her revolutionary E.A.T Method. Having personally experienced the transformative power of functional medicine, she’s on a mission to help others reclaim their health and vitality, enabling them to lead fulfilling lives.</p>


MCAS Innovations: New Paths In Diagnosis & Treatment

Meg Mill, PharmD, AFMCP

Kara Wada, MD

Summary

Content Provided By

Meg Mill, PharmD, AFMCP

Guest Experts

Kara Wada, MD