Below we outline various options in the treatment of Mast Cell Activation Syndrome MCAS UK. Simply making a diagnosis of MCAS can, in itself, be cathartic. Whereby, previously the person was often resigned to accept and tolerate a myriad of seemly chaotic symptoms, the possibility of easing some of them brings hope for the future.
There is no permanent cure, so management and treatment of MCAS is based on the avoidance of triggers, which may include cigarettes and alcohol, and implementing interventions to help control symptoms. These interventions include trying a low histamine diet, and taking histamine blocking medications. Histamine H1 and H2 blockers seem to bring clinically significant benefits to the majority of MCAS patients. Furthermore, H1 and H2 blockers are cheap and long term safe. Which combination of H1 and H2 works best for an individual is determined by trying them out.
The H1 and H2 blockers often need to be taken twice daily, rather than the usual once daily dosing. Examples of H1 blockers in the UK include Diphenlhydramine and Chlorphenamine (sedating), and Loratadine, Cetirizine and Fexofenadine (non-sedating).
H2 blockers in the UK include Cimetidine, Famotidine and Nizatidine. Of these Famotidine and Nizatidine are preferable, which is fortunate, as, currently, Cimetidine is out or stock. (January 2021). Again, twice daily dosing is required, rather than the use once daily dosing.
Mast cell stabilising drugs such as Sodium Cromoglicate, and leukotriene receptor antagonists such as Montelukast are also useful in treating MCAS. Over-the-counter Quercetin is also believed to have mast cell stabilising effects and can be taken in combination with the above.
Ketotifen has both H1 blocker and mast cell stabilising effects and is useful in some MCAS patients.
Benzodiazepines such as Lorazepam and Clonazepam have mast cell stabilising effects in addition to their effect on benzo receptors, and can be useful where anxiety is a prominent feature of MCAS.
Aspirin and NSAIDs such as Ibuprofen can be helpful in some MCAS patients, but be aware that these drugs can precipitate a reaction in a minority of patients.
High dose Vitamin C reduces histamine release from mast cells, and is certainly worth considering. High dose Vitamin D can also be useful.
Other much more toxic, and very much more expensive, medications, such as the KIT inhibitor Imatinib, can help in MCAS, and may be tried, cautiously, where other medications have not helped.
As the above shows there are several options in the treatment of Mast Cell Activation Syndrome MCAS UK. Most patients will see significant improvement in their symptoms with various tailor made combinations.
For more information on MCAS please do not hesitate to get in touch with Dr Deering through our appointments page.
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