Mast cell activation trial
Where the question has got to, what's still unmeasured, and a daily symptom log running across an unmedicated baseline week and the treatment period — with temperature recorded alongside, so a cooling August can't be mistaken for a drug effect.
Where this has got to For Dr Gemma Lewis
Written up 27 July 2026, after your message suggesting mast cell activation, possible hypermobility, and a few weeks of proper antihistamine cover.
Dose times 06:00 / 14:00 / 22:00 — 8-hourly, mapped onto Ade's actual day.
Baseline logged 27–28 July unmedicated · treatment days 1–14 from 29 July · review 12 August.
Clear no to thumb-to-forearm, dislocations, childhood contortion and self-described double-jointedness. Possible yes to hands-flat-to-floor, but limited by hamstring tightness from deconditioning rather than joint range — the least specific item on the questionnaire. Threshold is 2.
Photographed 27 July. Distal hyperextensibility at the thumb interphalangeal joint is a common anatomical variant and is not a Beighton or 5PQ item — it is a different joint from the thumb-to-forearm sign, which is negative. Noted here so it isn't carried forward as supporting evidence.
Removes the commonest benign explanation for flushing, palpitations and gut upset.
The objective limb of the diagnosis. A raised baseline would also open up hereditary alpha-tryptasemia, which fits heat and gut intolerance without needing hypermobility.
Heat intolerance, loose stools, fatigue and palpitations are also a straightforward hyperthyroid picture. Cheaper to exclude than to run a four-week drug trial around.
Reported as "monitoring, trending down". In a non-drinker that needs a stated cause — most plausibly metabolic, given Dec 2024 triglycerides 4.57 and HbA1c 5.7%, both since normalised (1.07 and 5.3%). Worth naming rather than assuming.
What would help Three things
- One blood form: serum tryptase + thyroid function Both routine, neither delays starting the antihistamines. Tryptase isn't affected by antihistamines, so timing against the trial doesn't matter.
- Famotidine as the next lever if the gut doesn't shift Cetirizine at 30mg/day should cover the skin and general picture well. Gut symptoms run substantially through H2 receptors, so if everything else improves and the gut doesn't, that's the obvious next step rather than a failed trial.
- Beighton score in person, 60 seconds To settle the hypermobility question properly rather than on a self-scored questionnaire confounded by tight hamstrings.
Today's log
Score each domain 0–3. 0 none · 1 noticeable · 2 interfering with the day · 3 severe. Score how the day was overall, not the worst single moment.
Doses actually taken today
Trend Total symptom score per day
Grey bars are baseline days, teal are treatment days. The amber line under each bar is that day's heat — if the teal bars only fall when the amber falls, the weather is doing the work, not the antihistamines.
Daily log
Onset — what predates the reading One-off
The cleanest defence against confirmation bias. Symptoms that were there long before you'd heard of any of this can't have been created by reading about it. Anything that only appeared afterwards should be treated with suspicion — by you and by Gemma. If a domain is scoring above zero in the daily log, it needs a real answer here rather than "unsure".
Hypermobility & tryptase One-off
The 5-part questionnaire is scored on "now or ever" — joint range drops with age, so childhood counts. Two or more yes answers suggests generalised hypermobility. Pre-filled from Ade's answers on 27 July 2026; question 1 is marked yes on the generous reading.
Summary for Gemma Copy at end of trial
Regenerate this whenever you want the current picture. It compares baseline against treatment, adjusts for the temperature difference between the two periods, and flags if the trial is not yet long enough to read.