Symptoms and manifestations of anaphylaxis recur in a stereotypic sequence in individuals

Abstract

An increasing number of patients are being referred to Allergy clinics for evaluation of mast cell activation syndrome (MCAS). A commonly cited complaint in this disorder is a non-specific condition commonly described as ''brain fog.'' Similar complaints have been noted in postural orthostatic tachycardia syndrome, and studies have found possible objective evidence of cognitive dysfunction in this disorder. Our overall goal is a quality improvement initiative to quantify symptom burden in patients with MCAS. For this part of the project, our aim is to evaluate whether cognitive dysfunction can be identified and monitored in a cohort of patients referred for MCAS. METHODS: In an ongoing quality improvement project (IRB exempt), patients referred to a University of Wisconsin Allergy clinic for evaluation of MCAS are being administered symptom questionnaires. Executive cognitive function is assessed via a previously validated computer battery (CogState), with individual tests including Detection, Identification, One Card Learning, One Back, and Groton Maze Learning. A PHQ-9 questionnaire is also administered to assess co-morbid depression. RESULTS: In a cohort of patients with presumed MCAS in the University of Wisconsin Allergy clinic, 25% of patient have self-reported symptoms of cognitive dysfunction and approximately one-third have physiciandiagnosed or self-reported depression. CONCLUSIONS: Referrals to the Allergy clinic for MCAS are increasing in number, and the diagnosis, monitoring and management of the disease remains challenging. Given the frequency of self-reported cognitive concerns, establishing objective measures is of utmost importance in monitoring and management of this disease.