The Histamine Bucket (and Mickey Mouse)

You may have heard of the Spoon Theory by Christine Miserandino to explain chronic illness. Spoons symbolize energy used on everyday tasks. Healthy people have an unlimited number of spoons to spend throughout the day. However, chronically ill people only have a limited number of spoons each day, because chronic illness zaps our energy. We learn to spend spoons more carefully, but never have enough.

MCAS has its own metaphor: The Histamine Bucket. Imagine your body is an empty bucket. Now imagine adding histamine to the bucket every time you did something. Here’s a list of examples that add histamine to the bucket:

• Showering
• Cleaning
• Eating
• Shopping
• Walking outside

Some activities fill the bucket quicker:

• Smelling perfume
• Sitting in the sun
• Drinking alcohol
• Getting stung by a bee
• Fluctuating hormone levels

Avoid an overflowing bucket at all costs. Too much histamine can cause life-threatening anaphylaxis. At the very least, an overflowing bucket could require Epi Pens and an ambulance ride (which is zero fun when your suffocating).

The emptier your bucket, the better you’ll feel. I don’t mean build a blanket fort and never leave. I mean prioritize your activities and rest in between. Of course, daily medications help too.

This is also why sometimes you tolerate a food one day, because your bucket is more empty, and the next day the same food can make you feel like death, because there’s no more room in your bucket.

So, that’s The Histamine Bucket metaphor.

I relate best to a third, more animated analogy. It also involves buckets, and Mickey Mouse. Yes, I’m talking about the Sorcerer’s Apprentice.

In this analogy, I’m Mickey and my mast cells are those naughty brooms. At first, my mast cells seem competent at their job. They empty their small buckets of mediators slowly and steadily. Pleased, I start daydreaming about doing All The Things. That’s when my mast cells go rogue. They turn their job into an incessant nightmare, filling my body with chemicals. Before I realize what has happened, I’m swimming in histamine, prostaglandins, and leukotrienes. I try to end the chaos with Benadryl, but those dang mast cells won’t be stopped. I’m in over my head. Am I going to die?

Finally, the sorcerer bursts in and gives Mickey an Epi. Okay, the end is a bit of a stretch. EMTs are generally way more friendly than that sorcerer.