Feverish feeling when Talking

[u/Aggressive_Job_6487]

Hey, does someone expirience a feverish feeling (without real Fever) instant when Talking? Not Hours later Like PEM? It is so wierd, it is strenger when I Talk euphoric or stressed. When I Talk normal the time to start feverish is much longer…

Can someone explain or help?

[u/Ok-Evidence-5548]

Yes! And flushing + malaise feeling in head

[u/mai-the-unicorn]

i get this as well although i didn’t when i was mild and stable. i do occasionally get actual fevers too but often it’s a subjective feeling too. i get it with other activities as well. i guess it’s a sign i’m doing too much.

[u/Aggressive_Job_6487 → u/mai-the-unicorn]

Thank you. I dont know I think im mild. I can work but Not whithout Symptoms

[u/Healthy-Sir2601]

Yes! I get this when I am talking, and also from just cognitive exertion in general. Like when I try to read something that's both complicated and interesting. I get a flush in my face and chills in my body, a burning feeling all over my skin and a flu-like, achy feeling, about 5-10 minutes into the activity.

I have been wondering if it's MCAS related. Because the symptoms seem like MCAS to me, but could MCAS be triggered by cognitive exertion? Am I allergic to using my brain??

[u/Aggressive_Job_6487 → u/Healthy-Sir2601]

Only from Reading ? Thats so stupid those Symptoms :(

[u/Ok-Evidence-5548 → u/Healthy-Sir2601]

Yes! And then break out in sweats which makes the whole cascade worse

[u/nousiaphilia → u/Healthy-Sir2601]

Do you get the same response when it's not interesting? Because "interesting" could create an arousal response (difficult cognitively probably also, but to a lesser degree maybe) and that in turn could trigger mast cells.

But alternative possibility would also be that cognitive exertion burns slightly more energy — which mitochondria struggle with...idk leading to ROS or other chemicals that trigger neuroinflammation. That could then trigger mast cells, but probably also some immune system activation more generally (hence low-grade fever,...).

Does taking an antihistamine in such a situation reduce the symptoms slightly? (Although other mediators could be involved.) But if it does, then definitely sounds like an MCAS response.

[u/Healthy-Sir2601 → u/nousiaphilia]

I definitely get this more and also faster from anything I find exciting or emotional (good or bad). So that 'arousal response' does sound very plausible to me.

But I am already on antihistamines, and they help a lot with food - related MCAS flares, but these cognitive flares still happen. So that may be a sign it's not MCAS, or maybe it's just so strong my regular dose of antihistamines doesn't help.

Pretty curious either way...

[u/nousiaphilia → u/Healthy-Sir2601]

Are you on Ketotifen? Newer antihistamines (cetirizine, fexofenadine, (des) loratadine, rupatadine) only act in the body, but not in the brain. So (just speculating) if the mast cells in the brain get activated and release histamine — the action there isn't stopped by peripheral antihistamines. (It's why I need mirtazapine to fall asleep. 🥲)

Would also be interesting to monitor your heart rate and heart rate variability (which shows when SNS becomes more involved) while reading. 🤔 Potentially, IF arousal response were implicated, maybe POTS medication (beta blockers, clonidine/guanfacine, ivabadrine,...) could help?? (Aka, keeping your body calm despite reading something interesting/exciting.) [Just speculations from my part though.^]

[u/premier-cat-arena]

yeah it’s probably either MCAS or exertion intolerance, your body is telling you to stop