Diagnosis of mast cell activation syndrome: a global "consensus-2".

The concept that disease rooted principally in chronic aberrant constitutive and reactive activation of mast cells (MCs), without the gross MC neoplasia in mastocytosis, first emerged in the 1980s, but only in the last decade has recognition of "mast cell activation syndrome" (MCAS) grown significantly. Two principal proposals for diagnostic criteria have emerged. One, originally published in 2012, is labeled by its authors as a "consensus" (re-termed here as "consensus-1"). Another sizable contingent of investigators and practitioners favor a different approach (originally published in 2011, newly termed here as "consensus-2"), resembling "consensus-1" in some respects but differing in others, leading to substantial differences between these proposals in the numbers of patients qualifying for diagnosis (and thus treatment). Overdiagnosis by "consensus-2" criteria has potential to be problematic, but underdiagnosis by "consensus-1" criteria seems the far larger problem given (1) increasing appreciation that MCAS is prevalent (up to 17% of the general population), and (2) most MCAS patients, regardless of illness duration prior to diagnosis, can eventually identify treatment yielding sustained improvement. We analyze these proposals (and others) and suggest that, until careful research provides more definitive answers, diagnosis by either proposal is valid, reasonable, and helpful.

Exploring measures of whole person wellness: integrative well-being and psychological flourishing.

OBJECTIVES: Whole systems of complementary and alternative medicine (WSCAM) emphasize positive emergent outcomes for the patient, for example, a sense of well-being. This paper presents a questionnaire-based study in healthy young adults for the purpose of exploring individual differences that contribute to the sense of well-being and to identify characteristics of flourishing versus nonflourishing individuals in terms of nonlinear dynamical systems concepts. METHODS: Young adult college students (N = 856) completed questionnaires assessing global well-being (Arizona Integrative Outcomes Scale [AIOS]), global physical health, positive and negative mood (Positive and Negative Affect Schedule [PANAS]), resilience (Connor- Davidson Resilience Scale), and repressive defensiveness. Next, subjects were divided into flourisher/languisher groups by a previously determined ratio of positive/negative scores established by a study using complex systems methods. RESULTS: Positive-to-negative affect (P:N) ratio accounted for more variance in AIOS (R(2) = 0.19; P < .001) than did separate positive or negative PANAS scores or physical health. Flourishers (14.5% of the sample) were significantly higher than languishers in defensiveness and resilience. CONCLUSIONS: Positive-to-negative affect explains a substantial portion of the variance in well-being of healthy young adults. The low percentage of flourishers in this nonclinical sample is consistent with previous population-based studies and suggests that flourishers are a minority, even in nonclinical settings. Positive-to-negative affect may be a useful variable for subsequent prospective studies of applied WSCAM treatments and in well and clinical populations. The well-being measure used in this study is easy to complete, sensitive, and may be a useful clinical measure to track change with treatment over time.