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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.<\/jats:p>","DOI":"10.1136\/bcr-2017-221405","type":"journal-article","created":{"date-parts":[[2018,1,11]],"date-time":"2018-01-11T04:58:14Z","timestamp":1515646694000},"page":"bcr-2017-221405","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment"],"prefix":"10.1136","volume":"2018","author":[{"given":"Leonard B","family":"Weinstock","sequence":"first","affiliation":[{"name":"Medicine, Washington University, Saint Louis, Missouri, USA"},{"name":"Gastroenterology, Specialists in Gastroenterology, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill B","family":"Brook","sequence":"additional","affiliation":[{"name":"Biostatistics, Private Practice, Anchorage, Alaska, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trisha L","family":"Myers","sequence":"additional","affiliation":[{"name":"Gastrointestinal Department, Specialists in Gastroenterology, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,11]]},"reference":[{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203316629558"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.amjms.2016.12.013","article-title":"Characterization of mast cell activation syndrome","volume":"353","author":"Afrin","year":"2017","journal-title":"Am J Med Sci"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.08.013"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.4","first-page":"157","article-title":"A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome","volume":"28","author":"Deb","year":"2015","journal-title":"Proc"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000158259.68614.40"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.6","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/nmo.12480","article-title":"Gastrointestinal dysmotility in postural tachycardia syndrome","volume":"27","author":"Loavenbruck","year":"2015","journal-title":"Neurogastroenterol Motil"},{"key":"2025082804491280000_2018.jan11_1.bcr-2017-221405.7","doi-asserted-by":"crossref","first-page":"527","DOI":"10.5603\/CJ.2011.0008","article-title":"Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. 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