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Most patients experience fatigue, fevers, and sensitivity to individualized environmental "triggers." Other commonly identified signs and symptoms are as follows: Hot flashes, irregular heartbeat, high or low blood pressure (hypotension and/or hypertension) vertigo, dizziness, forgetfulness, depression or anxiety, headaches, insomnia, restlessness hives or other visible skin rashes arthritis, muscle pain, bone pain, osteoporosis/osteopenia anaphylaxis (a severe allergic reaction) Malabsorption and gastrointestinal distress leading to low iron and low Vitamin D and low Vitamin B12 [2] Diagnosis MCAS can be difficult to diagnose as the cause of the syndrome is still considered to be unknown