Oefeningen bij MCAS — geleidelijke warming-up, temperatuur-gecontroleerd, premedicatie, EpiPen bereikbaar

Akin/Valent 2010 + Akin 2015 update + AAAAI/ACAAI 2020 consensus criteria. Mast cell activation syndrome is excessive mast cell mediator release WITHOUT the monoclonal mastocytosis bone marrow finding. Heterogeneous symptoms: flushing, urticaria, GI cramping, dysautonomia overlap (POTS comorbid commonly), and exercise-induced anaphylaxis risk. Triggers: high-histamine foods, alcohol, heat, cold, exercise itself, stress, fragrances. Exercise PROGRAMMING is what separates MCAS from a generic 'just move more' prescription: gradual warm-up (mast cell mediator release follows a stress curve — abrupt onset triggers peak release), indoor temperature-controlled environment (heat or cold can be the trigger), AVOID HIIT during stabilisation (the mediator-release peak in MCAS is dose-dependent on intensity), pre-medicate H1+H2 blockers 60-90 min pre per immunology, and EpiPen accessible at all times during exercise — exercise-induced anaphylaxis is a real risk in this population. Low-histamine diet (SIGHI list / Swiss Interest Group Histamine Intolerance) is trialed under dietitian + immunology guidance. AVOID alcohol (acetaldehyde drives mast cell degranulation) + NSAIDs (degranulation trigger; paracetamol/acetaminophen usually safer).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength, cat-cow for spinal mobility + parasympathetic, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic regulation (vagal tone modulates mast cells), standing-march for managed cardio (NOT running), sit-to-stand for functional, ankle-pump for circulation + POTS overlap, chin-tuck for cervical posture. The AI coach also knows the nutrition side — low-histamine diet (SIGHI) 4-8 week trial under dietitian + immunology, AVOID tyramine-rich foods (overlap with histamine: aged cheese, soy sauce, salami, pickled foods), AVOID alcohol + NSAIDs, DAO (diamine oxidase) supplementation pre-meal per immunology, quercetin 500-1000 mg/day + vitamin C 1-2 g/day for mast cell stabilising (Mlcek 2016), omega-3 1-3 g/day EPA+DHA, AVOID processed-meat nitrites + sulfites (preservatives in wine + dried fruit + processed meats), POTS overlap CRITICAL hydration ≥2.5 L/day + sodium 3-10 g/day if BP allows + small frequent meals. CRITICAL: TMS Alliance (The Mast Cell Disease Society) + AAAAI/ACAAI + allergy/immunology + dietitian with MCAS experience + emergency plan with EpiPen access + cardiology if POTS overlap. This is NEVER a replacement for allergy/immunology care.