The first day of the conference focused largely on MCAS, ME/CFS, POTS, and their causes, such as environmental mould/bacteria exposure or fungal colonisation in the body and chronic “stealth” infections.

Professor Pete Smith opened this day with his keynote address on the topic: Mast Cell Activation Syndrome(s). Prof Smith is one of Australia’s leading allergists, immunologists and medical researchers, running his clinic at Queensland Allergy Services in Southport, Queensland. He spoke about the evolution, biology and triggers of mast cells, chronic spontaneous urticaria, hyper alpha tryptasemia, outlined the criteria of the three main MCAS case definitions, serum tryptase and other markers for diagnosis, and pharmaceutical, nutraceutical, lifestyle and dietary treatments.

Before lunch on Saturday, Dr Graham Exelby from Mermaid Central Medical Clinic (research blog), gave an extensive lecture on: Postural Orthostatic Tachycardia Syndrome and Crossovers with Long COVID, Fibromyalgia and ME/CFS. Dr Exelby started with an overview of those interconnected syndromes, given their similar biochemical findings and symptoms such as post exertional malaise (PEM) and coat hanger pain, and how that neuroimmune cells such as microglial, astrocytes, and mast cells might be a contributor. Infections such as SARS-CoV-2 trigger components of the innate immune system including toll-like receptors (TLRs) and the downstream signalling of the cellular inflammation hub NK-kB, together promote neuroinflammation. Mitochondrial and amino acid dysfunction is also seen in these conditions, with documented lower reserves of ATP, and a shift to amino acid catabolism in ME/CFS especially. Specific gene polymorphisms were discussed, as was brainstem hypoperfusion as seen with SPECT and vertebral artery and vein flow studies.

After lunch, Prof Smith returned to deliver another keynote address on the topic of ME/CFS and Long COVID: Similarities and Differences. Preferring the term ME (myalgic encephalomyelitis) to chronic fatigue syndrome (CFS) he outlined its various diagnostic criteria, including its cardinal feature of post-exertional neuroimmune exhaustion (PENE, a.k.a. PEM). He then talked about Long COVID, its clinical case definition, common symptoms, and the term post COVID condition (PCC), which studies show can be caused either from infection or post vaccination. Prof Smith compared ME to Long COVID showing similar but not identical symptom and biomarker comparisons, including Griffith University NCNED’s (where Prof Smith is an Adjunct Professor) study showing increased volume changes in the brainstem and pons, for both conditions (ref).

Next he spoke of testing and treatments for ME and Long COVID including nutritional and supplemental strategies and the mitigation of harmful environmental factors before focussing on the main pharmaceutical intervention he employs, low-dose naltrexone (LDN). The NCNED team, including Prof Smith, has found that the TRPM3 receptor, and thus ion channels and flow of calcium and other cations, is not functioning properly in people with ME/CFS and Long COVID (ref1, ref2). Preclinical studies have shown that LDN can help restore the function of TRPM3 in isolated natural killer cells of ME/CFS patients (ref1, ref2), while clinical trials investigating LDN in both conditions are currently underway (NCNED Linktree).

Dr Sandeep Gupta from Lotus Holistic Medicine, on the Sunshine Coast, gave a power-packed lecture on Mould-Induced Mast Cell Activation Syndrome. This talk centred around a complex case, where the patient had MCAS due to exposure from a water-damaged building, and improved following mould and MCAS treatments, all titrated slowly due to their extreme sensitivity. Around this case study he spoke of what the data showed for the mechanism of fungal components activating mast cells, plus an overview of the research for mould illness, including for chronic inflammatory response syndrome (CIRS) and mycotoxicosis, and treatments including nasal vasoactive intestinal peptide.

Dr Hugh Derham from Bicton Medical Clinic in Perth, rounded out the day’s lectures with his on Inflammation, Infections & MCAS: Towards a Unifying Theory of Chronic Inflammatory Illnesses. He considers mast cells and MCAS to be a common pathway to inflammation across the majority of his patients diagnosed with ME/CFS, Long COVID, Fibromyalgia and tick-borne and other stealth infections. He also believes chronic infections such as Epstein-Barr virus, Babesia, Bartonella and GI parasites are significant mast cell triggers and must be treated to reduce the burden of microbes on the system and then outlined various antimicrobial treatment strategies.

This was followed by a Panel of all the speakers from the day, plus Dr Zane Sherif from Mermaid Beach Radiology, as they answered questions from the audience.

The second day focused mostly on the Microbiome and the Gut-Brain Axis, with a MCAS case study to finish off.

The first speaker of the day was Dr Leila Masson (website) from Tamarama, Sydney who gave a keynote on the topic: The Microbiome from Pregnancy Through Childhood. Dr Masson gave the audience an overview of microbiome vs microbiota, its functions, and a timeline of the microbiome, including how it shifts in pregnancy and its influence on foetal development. She spoke on how the baby’s microbiome alters depending on mode of delivery and how the infant’s microbiome is then influenced by feeding practices, such as being breastfed (ideal) or formula fed. The use of antibiotics and antacids, especially PPIs, during childhood can also have a profound negative effect on the child’s microbiome. Dr Masson gave lots of tips and treatment pearls for treating this paediatric population and mentioned she’s seeing a much higher incidence of issues with the microbiome in infants and children these days.

Dr Henry Butt, PhD is a microbiologist and managing director of BioScreen, who provide faecal microbial analysis, based in Melbourne. He lectured on the topic: Rome IV Criteria (2016): Functional Gastrointestinal Disorders, first explaining the Rome IV case definition of functional GI disorders: disorders of gut-brain interactions. He then spoke about evidence which supports the notion that the colonic pH of FGIDs/IBS patients is acidic and that the acidity of the colon can lead to a significant, and detrimental, change of the patient’s gut microbial ecosystem.

This talk was followed by Dr Rebecca Ryan (website) who is a Gastroenterologist and Hepatologist with a clinic on the Gold Coast. Dr Ryan specialises in, and spoke about, The Role of the Gut and Microbiome in the Gut-Brain Axis (GBA). She started with an overview of the GBA and the difference between eubiosis, which promotes a healthy nervous system, and dysbiosis, which promotes inflammation which in turn causes functional gut symptoms a.k.a. “IBS”. Treating dysfunction of the GBA (DGBA) involves identifying the danger, avoiding/removing the danger (if possible) and treating the dysfunction. Conditions often seen with DGBA are the trifecta: hEDS, hPOTS and MCAS, and to make a quadfecta, HPA axis issues, as dysfunction seen in one area leads to dysfunction in all areas. The low hanging fruit for intervention are addressing faecal loading, water and salt intake, and diet.

After the lunch break, Sydney-based integrative GP Dr Janet Kim (website) spoke on the topic: The Straw That Broke the Camel’s Back: Observations of Gut Dysbiosis Over a Decade Plus. During her talk, Dr Kim showcased over a decade of experience in testing and treating gut issues, primarily in mould illness patients. She began with an overview of coeliac disease (CeD) and non-coeliac gluten sensitivity (NCGS), and their genetics, including how much more common coeliac HLA genes are in her mould illness patients (69%), compared to the general population (~30%). The overall incidence of CeD and NCGS is rising possibly due to the increase of glyphosate and persistent organic pollutant use, but also other environmental and biological factors. Mould exposure decreases alpha melanocyte stimulating hormone (a-MSH) which increases gut hyperpermeability, leading to inflammation and immune reactions. CeD may also be linked to SIBO, increased serum prolactin, which can in turn increase autoimmunity, and glutathione depletion.

The final speaker on the Sunday was Reine DuBois, an integrative Naturopath at, and founder of, The Health Lodge in Byron Bay. She did a combined lecture and case study about: Integrating Naturopathic Principles and Practices in Managing MCAS. She began outlining the main symptoms of MCAS, and how as they line all nerve sheaths and endings, nervous system regulation is an essential first step for any patient. An overview of the DAO enzyme, which breaks down histamine in the GI tract, was given, and how using a low histamine diet can give the body time to replenish DAO enzyme stores. Diet was also outlined including that grains such as rice can be contaminated with mycotoxins, so that going grain-free, not just gluten-free, may be beneficial. The case study of a complex MCAS, mould, and stealth infection case, was then outlined with Reine enlisting the audience as “medical detectives” in piecing together the root cause of the patient’s problems and possible treatment options.

The day concluded with a Panel of all the speakers from the day where they answered questions from the audience.

In summary the ACIIDS 2024 Conference delivered helpful insights, perspectives and clinical pearls on complex chronic illnesses including MCAS, POTS, ME/CFS, Long COVID, chronic “stealth” infections, and the Microbiome and Gut-Brain Axis.

Saturday Panel

Sunday Panel

Review: Pamela Connellan and Caleb Rudd