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It's great. Thank you. So next week you're in the certain letter Miles who's come down from Lester cheese, a consultant hematologist on D has enormous interesting master activation, which, of course, is off great interest tea pots because of the overlap and perhaps wasn't a great interest to lots of other people until cove it, um when I think people start to realize that quite a lot of what we hear has something to do with histamine. So hopefully we will hear in enormous detail about how we way thank you for the invitation in society disclosures. Well, I, um on advisor to mass cell action broom on, they also have a pediatric could buy three board on. The other thing is that I've not had no bit, despite all my family, have been it on many of my patients yet so myself, a little bit about myself. Eso basically they are in a tin, the in cells, but hatred genius, though everywhere in the body and so they can cause symptoms anywhere on. We define muscle activation syndrome. It's part off a spectrum of myself disorders, which includes must oh cytosis where my first interests came in this area hereditary or for trips. Semen, which is a relatively new condition on some other conditions with a breath, a tim of muscle activation. The soldiers, Um, for instance, in our hematology clinic, we also see patients of anti prostituted syndrome who have my cell activations part of the condition. We? No, no, but my cells have a huge number of receptors over 200 and over a finds. The mediators have been destroyed, not alone in every cell. Obviously on they result in excessive release of inflammatory mediators, which responded triggers Ms or not normally but typically harmful, such as foods, perfumes, stress, exercise, things like that Onglyza wide range of symptoms across multiple body systems. So really need to be a general position that has been mentioned this morning to pull everything together for these patients were strong association. Is that what's on behind my bile? EDS. We call the try Specter on it is overlap in the symptoms, so G I symptoms could be due to parts that could be due to et explore. They could be due to myself lined in the gut on any individual patient. It could be very different to any other individual patient with my cell activation on in the same patient. Those symptoms were very over time and including the number of triggers which may escalate. So we tried to have these three diagnostic criteria. So multiple symptoms across a number of different body organ horses. Tissue systems on where possible. We tried to find evidence of my cell mediators in raised months. So in muscle activation syndrome, the sumatriptan is is often normal or load, although it's raised in conditions like mustard side taste, it's a 24 hour urine sample for any file histamine, or, more often, productive visit prostaglandin DND to or have to offer metabolites on. But But that collection needs to be had chills ride the collection on about through its transit to the lab, which is often are on issue, and then the third is a response or a least partial response to either must cell stabilizers or my son mediator blockers like that party histamines. So what evidence we got for some relationship between and casts on walk over it. So back in 2020 Doctor Afrin and colleagues and states before, with a position paper disgusting that post Poupard unless might be rooted in my cell activation or least some of the symptoms that results. We know that my cells are activated by the CO the virus on my cells, maybe a driver that cute for information in it. Also, they found the drugs with activity against myself. All the mediators are helpful in these patients on. We found that in our own experience, not a lot. But some under my cell patients seem to have less severe disease in a treat. Povid if they were stable on myself, stabilized. So they suggested. But my cell treatment may help in long have perfect. And they've highlighted the over things in symptoms between muscle activation on long Kobe It I liked it in bold on. We're also publishing, um, article showing something similar in this graph it where the Reds highlight it. Terms are shared between and casts on little coach it. So the same American bruhth at this time, like my leg one stop, um, developed further study in 2021. So they like us. The patient's muscle question there. When they turned from it as they approached a long rope it like this Facebook room, um, um recruited a number of them 136 patients. A little cove. It Most of them are female to assess their symptoms before on after having a probe it we had hundreds, six controls on 18 myself. Activation patients, most of whom also with email and S O they plotted. He's in a spider a lot on that safe if we just look at this in a section. So the general population control controls on Precose did long hope it pay participants in the study. They've got it exactly the same pattern in their symptoms on severity analysis, whereas postpone bit long patients on muscle activation patients before treatment. Also hard. Very similar symptoms and severity analysis. As the muscle activation symptoms were increased in loco been mimicking symptoms and severity reported by patients who haven't passed. So they concluded that the increased activation by a broom last cells induced by probate infection by various mechanisms actually didn't go into May and July at least part of the pathophysiology of long over it on suggested roots to effective treatment, as we use in muscle patients, so but the next few slides there, kindly supplied by my selection rooms, speeded a survey earlier this year on patients who are also medical professionals. There's been a significant influx to the muscle action brute for information on advice regarding myself. Symptoms, Um, after being inspected, the probe it. So this is a relatively small survey. There were 32 responses. Most of these were female on Georgie age between 30 and 50. About half experience the Q base off povid for a least two weeks, but most didn't require hospital care or oxygen is part of their acute process. So these are the results on the C G. I musculoskelatal in respiratory cardiovascular neurological symptoms law Well represented, Um and, um okay. Many of patients had been investigated and diagnosed with Potts, 14 out of the 32 but only five had had investigations on diagnosis of them casts on the singular small number with chronic fatigue or any. So they concluded based on this small sample. But cast seems to be it the condition that overlaps with the diagnosis of long coated keeping with the American groups confusions on pots on um, they haven't got information pre copay it as to whether this is a level development of them casts or whether they were some symptoms which were escalated. Pre existing health conditions. Okay, high proportion of the patients were investigated pots, but investigations their incomes for much less established, undertaking the lower frequency. So this'll profile multi system, for example, coverted particular with allergic or inflammatory symptoms of G I. Respiratory and skin present indicate that there's the wider assessment from my cell. Observation could be considered on guys always. You need to do some more research. So what tests and treatments that we got from those which are in the UK Not this many. Is that the country? Suddenly we can do soon tryptase because I've already said in the selective a shin. Most patients do have a normal low that we tend to chromogranin a. But often that's not humbled correctly in terms of keeping chilled. Doing transit. The most useful I found is the prostaglandin your, um, your prostate gland ins and it should be 24 hour kept chilled. So I just I mentioned previously on me for history again. 24 hour urine so briefly, what treatments have we got that we cover the use in the UK So, um, number one is always avoid triggers if they recognize what the triggers are. Current EpiPen if they have severe allergic reactions, each one and ht to receptor antagonists, which to be low, um, augments the effect of age one blockers myself stabilized. I'll mention again in the next slide. Want to lose a cast Monte Leukotriene in substance? So block the effects of liquid trying with the spine of myself, something that over the last few years I've used more often is low dose naltrexone, not Wellington. Too many people. This anti inflammatory agent has been around for many, many years on Do is often a useful a starting point to calm myself before the name of the other medications. Attention to foods void in processed foods aren't high history and fruits on. Having fresh food is important, then have been on medical management in such a mindful less and other coping strategies service dogs on then a few other things that were in back. It's because some of them are not easily available. Muscle stabilizers include sodium from like eight, which is really get specific. Eso if they're much abnormal myself, cause in the GI symptoms surgeon criminal like eight is a bitch stabilizer. For these, it's um, it's not large cap seals, and so some patients open the capsules of it. If they do react to the capital itself, they just get in the pure substance. Well, you taught of binge a substance which is a must have this must cell stabilizer as well as our history and activity. And then between D is myself stabilized. I didn't see helps by flavonoids like we're sitting on gluteal in on blocks of other substances which are not medical are often helpful for patients. Aspirin. We sometimes use that many patients react to that. So Okay, so So I came to this case history to walk very recently. So these are my just quick thoughts about it. So on the right, we've got some of the symptoms that I think could overlap with myself. Um, activation syndrome. Obviously, palpitations on heavy chest pain will be not necessarily myself. But there's a a syndrome called Trulicity drum, which is related to myself on this, a condition where there was a kid coronary syndrome. So so both cardiac related symptoms could be, um, must so and so my boots on the left here. Brain fog and fatigue. Bono's low dose naltrexone has been helpful in some of my patients on a good quality magnesium, especially these in three and eight. Which possible barrier? Obviously, if it's a carrier, a challenge blockers and would add in the H two montelukast way think that's relevant? Um, we always have to listen to what the patient saying on their concerns on for the support. But I always emphasize that this is not all in your head, but that the brain and the mind has an impact on the body as well. Take that into account. So being in a silo and second repair my preferred for cardiology opinion on be neurological opinion, I didn't think the bites used in low dose naltrexone for some of the neurological symptoms. At least it's been shown to be helpful in every three. My older I'm also thinking about this poor lady situation. Provide a letter of support and guidance for her employer. So I'll start on. Anybody got a question here in the room. But we've got one of the front when you get probably gonna take one, because we do have well start doing that. We do have weighed who gives a wing time. If I pronounce it wrong on from that mass cell activation. I mean, he's here with the stamps. Don't need your mass cell questions. If you've got any way you can calm it. Coffee. Break it Stuff. We've got one here in the front. Hi. I'm just for apples. I'm interested in my body, but I'm also interested in them and set up a trial of low dose naltrexone on. But I wondered how you are you able, Teo, are you working in the NHS? Yes. Yes. Are you able to prescribe get people here aerial? Surprisingly well. You could cross Jones. Yeah, way have. When I first started prescribing, it had to be a private prescription. And patients got it by her glasses. Pharmacy with a lot of experience. Um, more recently, Lester has got it on for memory, which is very unusual in that I have Well, it was actually, it was put in place by my pediatric colleague. So which I've benefited from, but it's, um, very future, Please, because there's a, uh, the rules and regulations about what can I can use have taken it on 22 g, please. Around the country house. Thank you. And I'm sure lots of people in the chapel have been interesting. Yeah, absolutely. And we don't did come through and I'll just make methods to it that it taken through. Let's just take another one is well, is that saying lots of people patients not responding to anti histamines and the GP says. But then it just isn't recognized condition. Is that anywhere that they could go to, especially when the patients out. Why I cannot afford private? Yeah, is there anyone? It's It's a huge problem on, but we're we're actually inundated because, yeah, very few places that really understanding or will take people partly because we were given a 20 minute new patients stopping the 10 minute follow ups lot. We have to somehow comma dating people. It's a very quick, short question, and then we'll come to you and set you up for Did you shots? He has to. PDS tool kit for anyone has a genius. Brilliant EDS to upset this year. So I'm lying in here. EDS. Tool kits from the RC GP includes M past for the People Online who couldn't hear a good shops and back. Is it really quick question with a really quick answer. Oh, maybe not. I was just going to say that in my experience, people with them casts come to us with very restricted diets. Um, sort of restricted histamine. I get further and further restricted, which opposes of problem in terms of their recovery, because they're often of restricted some some foods that actually might be eight in their recovery, such as the bike lab noise in those countries. And the thoughts on that, please. Yeah. Short books. Okay. Short story. No. Little do have that problem. I tell them not to severely restrict just the very high histamine foods. Possibly is saying, You know, today's if they think that might be relevant. Just trying. Thank you.