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Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment

Title
Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment
Publication Type
Journal Article
Research Type
Human
Reported as
Case Report/Series/Restrospective Study
Date
January 11, 2018
Authors
Leonard B Weinstock, Jill B Brook,Trisha L Myers, Brent Goodman
Institution
Washington University, Specialists in Gastroenterology, Mayo Clinic Arizona
Link
Abstract

A patient with severe postural orthostatic tachycardia syndrome (POTS ) and mast cell activation syndrome (MCAS) received immunotherapy with low-dose naltrexone (LDN), intravenous immunoglobulin (IVIg), and antibiotic therapy for small intestinal bacterial overgrowth (SIBO). A dramatic and sustained response was documented. The utility of IVIg in autoimmune neuromuscular diseases has been published, but clinical experience with POTS is relatively unknown and has not been reported in MCAS. As a short-acting mu-opioid antagonist, LDN paradoxically increases endorphins which then bind to regulatory T cells which regulate T-lymphocyte and B-lymphocyte production and this reduces cytokine and antibody production. IVIg is emerging as a promising therapy for POTS . Diagnosis and treatment of SIBO in POTS is a new concept and appears to play an important role.