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In MCAS, mast cellswhich line the blood vessels, nerves, and mucosal tissuesbecome hyper-responsive, inappropriately releasing massive amounts of histamine, cytokines, and other inflammatory mediators in response to minor environmental or internal triggers

These changes lead to progressive symptoms, with both increasing frequency and severity of vertigo and hearing loss

NICE recommends sleep hygiene measures and Cognitive Behavioural Therapy for Insomnia (CBT-I) as first-line treatments