Anne Maitland is both an MD and a PhD. She claims that key to her interest in diagnosing and treating patients with mast cell activation disorders lies in the difference between the ways she was trained to think for the two degrees. She says, “MDs are taught to profile patients. PhDs are taught to ask the right questions.” Instead of treating, say, atopic dermatitis or asthma as they become symptomatic, she learned to investigate the ties between these conditions. “The immune system, the respiratory system, and the digestive system are all tied together by the nervous system.”
Anne says that there’s a feeling in medicine that “if you can’t test for something, it doesn’t exist.” The time pressures of doctor-patient interaction compound the dilemma. “Neglecting patient stories has created a desert in which snake oil finds a niche.” By 2013, Maitland had begun to develop a reputation for diagnosing and treating mast cell disorders, after seeing a number of patients with connective tissue disease, but for whom data didn’t support a diagnosis of typical food allergies or of mastocytosis. In these patients, the skin, the gut, and the lungs, where the body confronts the environment, were all reactive.
Her fellow allergists, she believes, miss this diagnosis because they are primarily focused on the adaptive or acquired immune system. They test for IgE-mediated mast cell disorders, which are responsible for most atopy, and neglect the larger functioning of the mast cell in innate immunity. She says, “the immune system is like the Bible. It has an Old Testament and a New Testament. Studying only IgE-mediated mast cell activation is like studying the Bible only through the lens of the New Testament.”
Anne says that mast cells don’t start life as a problem. Trained as first responders at our borders to the outside world, “mast cells go through basic training, then are shipped out and stationed to different parts of our bodies. So rookie mast cells stationed in the skin differentiate to the needs of that skin environment, compared to mast cells situated in the gut or respiratory tract. Similar to a new recruit sent to a base in Hawaii versus Iraq.” Mast cells can become dangerous if a subset of them “goes rogue or mast cells are being great soldiers, but following bad orders.” Armies of rogue mast cells are rare (mastocytosis), but most allergists are familiar with mast cells following bad orders, such as reacting to IgE targeting harmless substances or allergens. “Patients with connective tissue disorders appear to have mast cells that are following bad orders, but we just haven’t figured out where these bad orders are coming from–the surrounding connective tissue, the local nerves, other local components of the immune system.”
Today, Dr. Maitland is a prominent authority on mast cell disorders in private practice in Tarrytown, New York who has referred many patients to Dr. Xiu-Min Li, and is scheduled to join Dr. Li as a regular consultant in her clinic in Mamaroneck, New York.
(This copy was written for last year’s conference and adapted from Traditional Chinese Medicine, Western Science and the Fight Against Allergic Disease)