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One of the more characteristic complaints I hear during an MCAS flare is “internal vibrating.” Patients often describe feeling completely still on the outside, while on the inside it feels like their entire body is buzzing, humming, trembling, or vibrating. I hear this surprisingly often in patients with active mast cell symptoms. It’s not specific enough to diagnose MCAS by itself—and internal tremor can occur in other neurologic or autonomic conditions—but when it appears alongside a patient’s
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