risky substances glossary

Short Definition:
Ethanol-containing beverages that can exacerbate vascular and mast-cell symptoms.

Long Definition + Context:
As a vasodilator, alcohol widens blood vessels, worsening POTS-related blood pooling and hypotension. It also directly triggers mast cells to release histamine, leading to flushing, headaches, and potentially severe MCAS flares. Red wine and beer contain high histamine and sulfites, magnifying reactions. Chronic use disrupts sleep and liver function, impairing medication and histamine breakdown. Most patients eliminate or strictly limit alcohol, using pre-medication (antihistamines) and hydration if consumed.

Short Definition:
The dual role of alcoholic drinks as vasodilators and histamine liberators.

Long Definition + Context:
Beyond general ethanol effects, many adult beverages (especially red wine, champagne, beer) contain free histamine and sulfites that trigger MCAS symptoms. “Histamine liberation” means alcohol provokes mast cells to degranulate without containing histamine itself. For MCAS/POTS patients, even a small drink can provoke dizziness, flushing, hives, or GI upset, so understanding both mechanisms is crucial to safe consumption decisions.

Short Definition:
Substances—food or environmental—that provoke IgE-mediated immune reactions.

Long Definition + Context:
True allergies (e.g., peanuts, bee venom) require strict avoidance and emergency preparedness (epinephrine autoinjectors). In MCAS, the immune system may overreact even to non–IgE triggers. Avoidance includes food labeling vigilance and environmental controls (dust-mite covers, hypoallergenic bedding) to reduce overall allergic and mast-cell–mediator load.

Short Definition:
Substances—food or environmental—that provoke IgE-mediated immune reactions.

Long Definition + Context:
True allergies (e.g., peanuts, bee venom) require strict avoidance and emergency preparedness (epinephrine autoinjectors). In MCAS, the immune system may overreact even to non–IgE triggers. Avoidance includes food labeling vigilance and environmental controls (dust-mite covers, hypoallergenic bedding) to reduce overall allergic and mast-cell–mediator load.

Short Definition:
Foods that provoke reactions due to structural similarity with known allergens.

Long Definition + Context:
E.g., birch-pollen allergy leading to itching from raw apples (Oral Allergy Syndrome), or latex allergy cross-reacting with banana or avocado. Cooking often denatures the proteins. MCAS patients should identify and avoid raw cross-reactive items to prevent pruritus, GI upset, or systemic flares.

Short Definition:
The process by which mast cells release histamine and other mediators.

Long Definition + Context:
Triggers—food, stress, temperature change—cause mast-cell granules to “explode,” releasing histamine, tryptase, leukotrienes, and cytokines. These mediators produce symptoms from hives and flushing to hypotension and anaphylaxis. Avoidance of known triggers reduces degranulation frequency and severity.

Short Definition:
Environmental temperature extremes that provoke vascular or mast-cell reactions.

Long Definition + Context:
Heat dilates vessels, worsening POTS blood pooling and potentially triggering cholinergic urticaria (heat hives) in MCAS. Cold can precipitate Raynaud’s vasospasm or cold-induced urticaria. Patients manage exposure with climate control, appropriate clothing, and pacing outdoor activities to prevent symptomatic crises.

Short Definition:
Volatile chemicals in perfumes, cleaning agents, and smoke that can trigger symptoms.

Long Definition + Context:
Many MCAS patients and migraine-prone individuals react to chemical scents with headaches, flushing, or respiratory distress. Avoidance strategies include using fragrance-free products, ensuring good ventilation, and politely requesting a scent-free environment when visiting others.

Short Definition:
A protein in wheat, barley, and rye that causes autoimmune or sensitivity reactions.

Long Definition + Context:
In celiac disease, gluten ingestion triggers gut mucosal damage and systemic inflammation. In non-celiac sensitivity, symptoms (brain fog, joint pain, GI upset) may improve with a gluten-free diet. Strict avoidance—checking labels and cross-contamination—is vital for gut health and reducing overall inflammatory burden.

Short Definition:
Exaggerated symptoms (dizziness, tachycardia) upon exposure to warmth.

Long Definition + Context:
POTS patients experience blood-volume shifts when heated, leading to orthostatic intolerance. MCAS patients may get heat hives or flares. Recognizing heat intolerance informs lifestyle choices—avoiding hot baths, midday sun, and saunas—to maintain hemodynamic stability and prevent mast-cell activation.

Short Definition:
Fermentable carbs that can provoke IBS and mast-cell–mediated GI symptoms.

Long Definition + Context:
Foods rich in FODMAPs (garlic, onion, beans, certain fruits) ferment in the gut, causing bloating, pain, and diarrhea. For those with comorbid IBS or MCAS-GI involvement, temporarily eliminating high-FODMAP items and reintroducing carefully can reduce GI distress.

Short Definition:
A metaphor for cumulative histamine load from multiple sources.

Long Definition + Context:
Each histamine input—food, drink, stress, infection—fills the bucket. MCAS patients have smaller buckets and may decompensate when the level exceeds their threshold. Tracking and spacing triggers (e.g., not combining high-histamine foods with alcohol) helps keep levels below the symptomatic threshold.

Short Definition:
Edibles naturally high in histamine or that stimulate its release.

Long Definition + Context:
Includes aged cheeses, cured meats, fermented products, wine/beer, tomatoes, and leftovers. Avoiding or minimizing these reduces baseline mast-cell activation and prevents flushing, headaches, and GI upset in MCAS patients. Cooking fresh and freezing extras promptly are key strategies.

Short Definition:
A personalized compendium of known mast-cell triggers.

Long Definition + Context:
Patients compile foods (histamine, sulfites), drugs (opioids, contrast agents), and environments (fragrances, mold) that provoke flares. Maintaining and reviewing this list guides avoidance strategies and emergency preparedness.

Short Definition:
Adverse reactions to specific medications beyond typical side effects.

Long Definition + Context:
Many MCAS patients avoid opiates (histamine releasers) and certain anesthetics (trigger anaphylactoid reactions). POTS patients may find beta-agonist inhalers provoke tachycardia. Documenting intolerances on medical alert IDs ensures safer care.

Short Definition:
Practical strategies to minimize exposure to indoor mold spores and mycotoxins.

Long Definition + Context:
Prevent mold growth and exposure by promptly fixing water leaks, using dehumidifiers, installing HEPA air filters, and cleaning high-risk areas (bathrooms, basements) with mold-resistant products. Regular inspection and maintenance of your home environment reduce respiratory, GI, neurological, and mast-cell–mediator symptoms in susceptible individuals.

Short Definition:
Contact with airborne mold spores that can trigger allergic and inflammatory reactions.

Long Definition + Context:
Damp, water-damaged environments foster mold proliferation. In EDS/POTS/MCAS patients, inhaled spores and volatile organic compounds can provoke asthma-like symptoms, sinus congestion, headaches, and systemic mast cell activation. Remediation—repairing water damage, improving ventilation, and avoiding musty areas—is key to preventing these flares.

Short Definition:
MCAS flares specifically provoked by mold spores or mycotoxins.

Long Definition + Context:
Mold antigens and associated biotoxins can directly cause mast cells to degranulate, releasing histamine, leukotrienes, and other mediators. This results in respiratory distress (wheezing, bronchospasm), dermatologic reactions (hives, itching), headaches, GI upset, and systemic inflammation. Avoidance of moldy environments and use of protective measures (e.g., masks, air purifiers) are critical to reducing these unpredictable and potentially severe reactions.

Short Definition:
Pain relievers like ibuprofen and naproxen that can trigger mast-cell and airway reactions.

Long Definition + Context:
NSAIDs may provoke severe reactions (AERD) by shunting arachidonic acid toward leukotriene production. They can also irritate the GI tract. MCAS patients often avoid them; acetaminophen is preferred when tolerated.

Short Definition:
Activities that pose high risk of trauma or joint damage.

Long Definition + Context:
High-impact sports, heavy lifting, or extreme yoga poses can sublux or dislocate hypermobile joints in EDS and trigger pain or mast-cell flares. Avoiding or modifying such activities protects connective tissues and prevents inflammatory cascades.

Short Definition:
Applying a small amount of a new lotion or cream to the skin to test for reactions.

Long Definition + Context:
MCAS patients often react to personal-care chemicals. Patch testing (e.g., on the forearm) before full use prevents widespread hives or dermatitis.

Short Definition:
Illicit or non-prescribed psychoactive substances that pose cardiovascular and immune risks.

Long Definition + Context:
Stimulants (cocaine, amphetamines) dangerously raise heart rate and blood pressure—catastrophic in POTS or vEDS. MDMA can precipitate dysautonomic crises and MCAS events. Cannabis may lower BP and cause dizziness; medical use should be supervised.

Short Definition:
Tobacco or vaping products delivering nicotine, a potent vasoconstrictor.

Long Definition + Context:
Nicotine constricts blood vessels, impairing circulation and worsening Raynaud’s, POTS tachycardia, and wound healing in EDS. Smoking also increases systemic inflammation and collagen damage. Quitting reduces these risks, improving oxygen delivery, healing, and overall inflammation.

Short Definition:
Food preservatives (sulfur dioxide, sodium bisulfite) that can provoke mast-cell and asthmatic reactions.

Long Definition + Context:
Found in wine, dried fruits, condiments, and packaged foods, sulfites irritate mast cells, causing flushing, wheezing, or anaphylactoid responses. Label vigilance (FDA requires >10 ppm disclosure) and choosing sulfite-free products are key avoidance strategies.

Short Definition:
Ultraviolet light provoking skin or systemic reactions in sensitive individuals.

Long Definition + Context:
Certain autoimmune conditions (e.g., lupus), medications (tetracyclines, diuretics), and MCAS can cause photosensitivity—rashes, burning, or systemic flares. Protective measures include broad-spectrum sunscreen, UPF clothing, and limiting midday sun to avoid this environmental “substance.”

Short Definition:
Any factor—substance, environment, or emotion—that provokes symptoms.

Long Definition + Context:
Triggers span foods (histamine-rich), drugs (NSAIDs, opiates), environments (heat, mold), and stress. Identifying and cataloging personal triggers enables targeted avoidance to minimize flares and maintain quality of life.