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One of the hallmark signs of MCAS is a cyclical waxing and waning of symptoms with varying degrees of intensity depending on what exactly triggers your misbehaving mast cells

Annu Rev Immunol

[65] Other enzyme inducers, including certain anticonvulsants such as carbamazepine and phenytoin, may similarly reduce melatonin efficacy and necessitate dose adjustments

Systemic Effects Beyond local reactions, some participants in aod 9604 peptide studies report systemic effects: Mild Headaches : Occurring in approximately 5-8% of research subjects, these typically resolve within hours and may be related to initial adaptation to the peptide

Dinner can either help or make it worse