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Telehealth Access : Conduct all evaluations and follow-ups from home

These symptoms are usually most pronounced when starting treatment or increasing doses, and often improve over time

This creates a well-documented vicious cycle: stress increases histamine release, histamine amplifies nervous system reactivity (histamine H3 receptors modulate neurotransmitter release, and elevated brain histamine disrupts sleep, worsens anxiety, and heightens stress perception), which in turn drives more stress and further mast cell activation

The temporal link to dose escalation was notable: the patient had been stable on 3 mg, he had escalated to 7 mg, and within 2 weeks, he met criteria for a moderate-to-severe episode