Why Does MCAS Not Respond to Standard Treatment? The Four Mechanistically Distinct Patterns — Why each pattern needs different intervention

The reason MCAS treatment fails so often is that the same intervention is applied across patterns that need different interventions. Pattern A needs barrier work first and stabilization second. Pattern B needs autonomic work first and stabilization second. Pattern C needs exposure removal first and stabilization third. Pattern D needs stabilization and specialist consultation. When cromolyn is given to a Pattern A patient, it helps because cromolyn is mucosally active, but it helps incompletely because the barrier failure continues to signal. When the same cromolyn is given to a Pattern B patient, it helps less because the lesion is not at the mucosal mast cell. When it is given to a Pattern C patient, it helps less still because the cells are responding appropriately to a continuing trigger. When it is given to a Pattern D patient, it helps to varying degrees depending on the clonal burden, but the underlying mast cell disease is not addressed. The clinical literature reports this as inconsistent cromolyn response. The literature is correct. The interpretation that this represents inconsistent disease, requiring stronger stabilization or longer trial, is incorrect. The interpretation that it represents inconsistent stratification, requiring different interventions for different patterns, is what the case work suggests. This is why the same patient who responds partially to cro