NEVER BET AGAINST OCCAM:
MAST CELL ACTIVATION DISEASE
AND THE MODERN EPIDEMICS OF CHRONIC ILLNESS
AND MEDICAL COMPLEXITY
By Lawrence B. Afrin, MD
Published by Sisters Media, Bethesda, MD, 2016, pp 456
First, the title: Occam (some of you may be familiar with Occam’s Razor) was a philosopher, who, several centuries ago put forth the idea that if something is really complicated, the explanation that is closest to the truth is the one that explains as many of the complications as possible. Despite the unique name, this book is one of several that has changed the way I see patients who present with complicated stories. While I had been aware of mast cell activation for several years, my understanding of it was limited to thinking of mast cell activation as merely an inappropriate release of histamine, primarily from the GI tract when it came into contact with foods or liquids that were uniquely reactive to it. Dr. Afrin has done a marvelous service by helping us to understand just how complicated and varied are the presentations of mast cell activation. Several of my patients (for whom I had recommended this book) noted that it was a bit technical from the medical side (it is) but also reported that they had learned a great from reading it. Dr. Afrin takes mast cell activation system-by-system through the body, showing the extensive possibilities of how this illness may manifest or present to the patient or physician. Central to this is recognizing the possibility of mast cell activation as a contributing diagnosis for any symptoms that are complicated and do not fit into a nice, neat medical label.
Dr. Afrin does a nice job of explaining how difficult it is to make a clear diagnosis, and goes through the possibilities in detail. Once recognizing that mast cell activation may be occurring for any individual
(surprisingly, in up to 10% of our population) he then reviews the options for treatment in detail.
For patients who have been long-frustrated after seeing many physicians who have not been able to offer a clear explanation for their illness, here are some answers. I am grateful to Dr. Afrin for providing us with this book—-it is the first time I have seen the full picture of the extent of what mast cell activation represents and it gives us hope for improving our ability to diagnose and treat this condition.
(Readers may want to listen to the podcast I did with Dr. Afrin in September, 2016 on my radio show “The Cutting Edge of Health and Wellness Today” which is easily accessed through the tab Radio Shows).