Physical Exercise as a Trigger and Therapeutic Tool in Mast Cell Activation Syndrome. A Narrative Literature Review of Mechanisms and Management Strategies
DOI:
https://doi.org/10.12775/JEHS.2026.93.72700Keywords
mast cell activation syndrome, exercise-induced anaphylaxis, histamine, mast cell stabilizers, POTS, exercise intolerance, low-histamine diet, tryptaseAbstract
Background. Mast Cell Activation Syndrome (MCAS) is characterized by episodic, inappropriate release of mast cell mediators producing multisystem symptoms. Physical exercise acts both as a trigger for anaphylactic events and as a potential therapeutic modality in MCAS.
Aim. This review synthesizes evidence on MCAS pathophysiology, flare-up prevention strategies, and the bidirectional relationship between physical exercise and mast cell activation.
Material and methods. PubMed, Scopus, and Web of Science were searched using terms related to mast cell activation syndrome, exercise-induced anaphylaxis, and mast cell stabilization. Articles published between 1985 and 2025 were included, prioritizing consensus documents, systematic reviews, and original research.
Results. MCAS is classified into primary (clonal), secondary, and idiopathic forms, with diagnosis requiring multisystem symptoms, mediator elevation, and therapeutic response. Exercise triggers mast cell degranulation through osmolar, thermal, and neuroimmune mechanisms, yet structured moderate-intensity programs adapted from postural orthostatic tachycardia syndrome (POTS) rehabilitation protocols show benefit when combined with pharmacological premedication.
Conclusions. MCAS management in physically active individuals requires individualized trigger identification, stepwise pharmacotherapy, and graded exercise prescription. Randomized trials of exercise protocols designed for MCAS populations remain an unmet research need.
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