Aspirin can reduce the ability of mast cells to fire, it can reduce mast cell activation. And aspirin can also trigger mast cell activity, it can lead to allergic reactions (including potentially fatal anaphylaxis) and asthma. It is a somewhat risky tool for people with mast cell activation issues. People who have mast cell disorders may want to avoid aspirin unless under the supervision of a doctor.
The prudent course of therapy involves aspirin desensitization (usually while on large doses of H1 and H2 antihistamines), followed by rather large doses of aspirin. It requires emergency rescue options if anaphylaxis or asthma is triggered. In addition to the risk of allergic reactions, this course of action also carries a risk of internal bleeding, ulcers, and other complications - which may be higher if there are hyperactive mast cells in the gut that go beserk when aspirin is present. All in all, lots of issues.
Here are some articles that show that aspirin can cause serious side effects in people with mast cell disorders:
“Aspirin activation of eosinophils and mast cells: implications in the pathogenesis of aspirin-exacerbated respiratory disease.” Journal of Immunology, Jul 1, 2014, PMID 24890720.
“The broken balance in aspirin hypersensitivity.” European Journal of Pharmacology, 8 Mar 2006, PMID 16457808.
The second article suggests that aspirin intolerance is caused by a ‘broken balance’ in the body that might be triggered by viral infection, and when that hypersensitivity is in play, the body produces lots of leukotrienes after exposure to a little aspirin.
Here are some articles that demonstrates that aspirin can be used to treat mast cell disorders.
“Prevention of mast cell activation disorder-associated clinical sequelae of excessive prostaglandin D(2) production.” International Archives of Allergy and Immunology, 2008, PMID 18622141.
Bottom Line
While aspirin is listed as one of the standard therapies for mast cell activation syndrome, it has a lot of drawbacks. I would consider aspirin if my doc presented it as a recommendation, but am leery of it. It might help - but this is a case where patients need to do their due diligence.