ArticleBMJ case reports2018
Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment.
Article in BMJ case reports, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- The Investigation and Management of the Abdominopelvic Vascular Compression Syndromes in Patients with Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder.Vascular health and risk management · 2026Pooled it
- Low-Dose Naltrexone: What is the Evidence? A Narrative Review.Advances in therapy · 2026Review
- Prevalence and treatment response of neuropsychiatric disorders in mast cell activation syndrome.Brain, behavior, & immunity - health · 2025Article
- Real-World Effectiveness and Tolerability of Low Dose Naltrexone to Treat Chronic Pain: A Retrospective Cohort Study of One Pain Physician's Practice.Journal of pain research · 2025Article
- Immunotherapies for postural orthostatic tachycardia syndrome, other common autonomic disorders, and Long COVID: current state and future direction.Frontiers in cellular and infection microbiology · 2025Review
- Mast cell activation syndrome: Current understanding and research needs.The Journal of allergy and clinical immunology · 2024Review
- Novel Mechanisms of Postural Hyperventilation in Postural Orthostatic Tachycardia Syndrome: Toward Discovery of Terra Incognita.JACC. Basic to translational science · 2024Article
- Long-Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes.Journal of the American Heart Association · 2024Article
- Postural Orthostatic Tachycardia Syndrome (POTS) as an Adverse Event to the Human Papilloma Virus (HPV) Vaccine and Its Relationship with Ehlers-Danlos Syndrome (EDS).Reports (MDPI) · 2024Article
- Autoimmunity in Syndromes of Orthostatic Intolerance: An Updated Review.Journal of personalized medicine · 2024Review
- Overlapping conditions in Long COVID at a multisite academic center.Frontiers in neurology · 2024Article
- Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series.Journal of personalized medicine · 2023Article
- Article
- Diagnosis and Management of a Hypersensitivity Reaction to Titanium-Containing Surgical Clips: A Case Report.Cureus · 2023Article
- Narrative Review of Postural Orthostatic Tachycardia Syndrome: Associated Conditions and Management Strategies.US cardiology · 2023Review
- Autoimmunity in Long Covid and POTS.Oxford open immunology · 2023Review
- Efficacy and toxicity of hydroxyurea in mast cell activation syndrome patients refractory to standard medical therapy: retrospective case series.Naunyn-Schmiedeberg's archives of pharmacology · 2022Article
- Article
- Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1.Autonomic neuroscience : basic & clinical · 2021Article
- Mast Cell Activation Disorder and Postural Orthostatic Tachycardia Syndrome: A Clinical Association.Journal of the American Heart Association · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A patient with severe postural orthostatic tachycardia syndrome (POTS) and mast cell activation syndrome (MCAS) received immunotherapy with low-dose naltrexone (LDN) and intravenous immunoglobulin (IVIg) and antibiotic therapy for small intestinal bacterial overgrowth (SIBO). A dramatic and sustained response was documented. The utility of IVIg in autoimmune neuromuscular diseases has been published, but clinical experience with POTS is relatively unknown and has not been reported in MCAS. As a short-acting mu-opioid antagonist, LDN paradoxically increases endorphins which then bind to regulatory T cells which regulate T-lymphocyte and B-lymphocyte production and this reduces cytokine and antibody production. IVIg is emerging as a promising therapy for POTS. Diagnosis and treatment of SIBO in POTS is a new concept and appears to play an important role.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.