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two of those patients were on both metformin and PPI

Mast cell activation syndrome (MCAS) flares up when mast cells, which are located throughout the body, inappropriately release excessive amounts of chemical mediators, such as histamine, in response to a trigger, including one or more of the following: Alcohol An allergen Certain chemicals Certain food items (which vary among individuals) Certain fragrances (such as perfume or cologne) Certain medications Exposure to sunlight Heat or cold Heavy metals Infection (bacterial, viral, or fungal) Mold/fungus When mast cells function as they should, they help defend the body against threats, such as harmful viruses, bacteria, and fungi

It appears that there may not be a requirement for dose adjustment specifically for patients with liver issues

When this happens, symptoms may appear