Hi, I can comment a bit about the mast cell side of things. Flushing tends to result from high levels of prostaglandins, which are released by mast cells. In mast cell activation syndrome (MCAS), mast cells tend to be badly behaved and will release their chemicals to improper triggers. Heat is a common trigger for many. Daily histamine blocking medications can help (like Zyrtec or Allegra here in the US), as can mast cell stabilizers (cromolyn sodium or ketotifen). There are also h2 histamine blockers more commonly known for acid blocking like Zantac or Pepcid that should be tried along with the other histamine blockers. Worth noting that ketotifen is terribly hard to obtain in the US because of its FDA status, it’s legal but not manufactured here. It can be gotten from overseas or compounded, but most doctors here aren’t familiar with it or the process. If you can get it OTC in Australia, I would recommend trying it. Prostaglandins can be tested via a 24 hour urine test for prostaglandin f2a, which I believe is a metabolite. High prostaglandins are commonly treated with aspirin, but be very cautious since those with MCAS are often triggered by NSAIDs (aspirin, ibuprofen, naproxen), and only do with doctor supervision. I’ve seen in our MCAS groups that mangosteen supplements are supposed to help regulate prostaglandins, but I haven’t tried myself. Incidentally, I have high prostaglandins but no flushing. It is also worth becoming familiar with common mast cell triggers and determining if any make your episodes worse so you could avoid the triggers. Reactions to triggers may be subtle; I was having low level reactions for years to ibuprofen showing up as skin eruptions around my mouth, but no doctor could ever figure it out. It wasn’t until ibuprofen also started making me itchy that I figured it out, avoiding has greatly reduced my skin reaction. Another common trigger you should be aware of is alcohol. I finally figured out I was having similar low level chronic reactions to just small amounts of alcohol, beer and wine being worst. I stopped having any about 18 months ago, and when I think it’ll be ok “just this once”, I now pay massively with a quite spectacular reaction. All of the little triggers that you get exposed to regularly can add up to a very mysterious reaction like flushing. Daily meds can help, especially to help you determine if you are looking in the right direction, but it usually comes down to identifying your own personal triggers and avoiding them.
Leslie