Autonomic function testing and symptom severity in patients with suspected mast cell activation disorders

Amro M Stino; Jodi Nelson; Olivia Gutgsell; Ahmed Eldokla; Jasmine Liu; Cem Akin

doi:10.1016/j.autneu.2025.103362

Autonomic function testing and symptom severity in patients with suspected mast cell activation disorders

Auton Neurosci. 2025 Dec:262:103362. doi: 10.1016/j.autneu.2025.103362. Epub 2025 Nov 17.

Authors

Amro M Stino¹, Jodi Nelson², Olivia Gutgsell³, Ahmed Eldokla⁴, Jasmine Liu⁵, Cem Akin⁶

Affiliations

¹ Department of Neurology, University of Michigan, UH South F2647, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. Electronic address: amstino@med.umich.edu.
² Department of Neurology, University of Michigan, UH South F2647, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
³ Department of Neurology, University of Michigan, UH South F2647, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. Electronic address: olivia_gutgsell@rush.edu.
⁴ NY Neuromuscular Healthcare, 5 Kennedy Pkwy, Cortland, NY, 13045, USA. Electronic address: eldoklaa@nyneuromuscle.com.
⁵ Department of Neurology, University of Michigan, UH South F2647, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. Electronic address: jasmliu@umich.edu.
⁶ Division of Allergy and Immunology, Department of Internal Medicine, University of Michigan, Suite H-2100, 24 Frank Lloyd Wright Dr., Ann Arbor, MI, 48106, USA. Electronic address: cemakin@med.umich.edu.

PMID: 41265079
DOI: 10.1016/j.autneu.2025.103362

Abstract

We assessed both objective and subjective measures of autonomic severity in patients with formally classified mast cell activation disorder (MCAD), hereditary alpha tryptasemia (HaT), and systemic mastocytosis. In all subjects, autonomic disease severity was objectively mild but subjectively moderate to severe. The presence of MCAD did not yield consistent differences on subjective or objective severity measures, although HaT did associate with lower objective (but not subjective) severity measures. In conclusion, assessment of MCAD and related disorders can be conducted using formal classification criteria, and in those with suspected dysautonomia, the workup should incorporate objective and subjective measures of dysautonomia.

Keywords: CASS; COMPASS; Disease severity; Dysautonomia; Hereditary alpha tryptasemia; Mast cell activation.

MeSH terms

Adult
Aged
Autonomic Nervous System Diseases* / diagnosis
Autonomic Nervous System Diseases* / physiopathology
Autonomic Nervous System* / physiopathology
Female
Humans
Male
Mast Cells*
Mastocytosis* / complications
Mastocytosis* / diagnosis
Mastocytosis* / physiopathology
Middle Aged
Severity of Illness Index
Tryptases / deficiency

Substances

Tryptases