What are the best treatments for Mastocytosis and MCAS?

Treatments for Mastocytosis and MCAS

Mastocytosis and Mast Cell Activation Syndrome (MCAS) are rare conditions characterized by an abnormal accumulation and activation of mast cells in various tissues of the body. These conditions can cause a wide range of symptoms, including skin rashes, gastrointestinal issues, cardiovascular problems, and allergic reactions. While there is no cure for Mastocytosis and MCAS, there are several treatment options available to manage symptoms and improve quality of life.

1. Medications

Medications play a crucial role in the treatment of Mastocytosis and MCAS. The primary goal is to stabilize mast cells and prevent them from releasing excessive amounts of histamine and other inflammatory substances. Some commonly prescribed medications include:

• Antihistamines: These drugs help block the effects of histamine, reducing symptoms such as itching, flushing, and gastrointestinal distress. Over-the-counter antihistamines like cetirizine or prescription-strength ones like hydroxyzine may be used.


• Leukotriene inhibitors: These medications block the action of leukotrienes, which are inflammatory substances released by mast cells. Montelukast is a commonly prescribed leukotriene inhibitor.


• Mast cell stabilizers: Cromolyn sodium is a mast cell stabilizer that can prevent mast cells from releasing histamine and other inflammatory substances.


• Epinephrine autoinjector: For severe allergic reactions or anaphylaxis, an epinephrine autoinjector may be prescribed to provide immediate relief.

2. Avoiding Triggers

Avoiding triggers that can activate mast cells is an essential part of managing Mastocytosis and MCAS. Identifying individual triggers can be challenging, as they can vary greatly from person to person. Common triggers include certain foods (e.g., shellfish, alcohol, spicy foods), temperature changes, stress, medications (e.g., NSAIDs, opioids), and insect bites. Keeping a detailed diary of symptoms and potential triggers can help identify patterns and guide avoidance strategies.

3. Diet Modifications

Modifying the diet can be beneficial for individuals with Mastocytosis and MCAS. While specific trigger foods can vary, some general dietary recommendations include:

• Avoiding known trigger foods: Eliminating foods that have been identified as triggers can help reduce symptoms. Working with a healthcare professional or dietitian experienced in mast cell disorders can be helpful in identifying trigger foods.


• Following a low-histamine diet: Histamine is naturally present in certain foods and can trigger mast cell activation. Following a low-histamine diet involves avoiding or limiting high-histamine foods such as aged cheeses, fermented foods, and processed meats.


• Considering a low-FODMAP diet: Some individuals with MCAS may benefit from following a low-FODMAP diet, which restricts certain carbohydrates that can trigger gastrointestinal symptoms.

4. Symptom-Specific Treatments

Depending on the specific symptoms experienced, additional treatments may be recommended:

• Topical treatments: For skin-related symptoms like rashes and itching, topical corticosteroids or antihistamine creams may provide relief.


• Proton pump inhibitors (PPIs): PPIs can help manage gastrointestinal symptoms such as acid reflux and stomach ulcers.


• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) should generally be avoided, but in some cases, selective COX-2 inhibitors may be prescribed to manage pain and inflammation.


• Immunomodulatory medications: In severe cases, medications that suppress the immune system, such as corticosteroids or immunomodulators, may be prescribed to reduce mast cell activity.

5. Supportive Measures

Supportive measures can complement medical treatments and help individuals cope with the challenges of living with Mastocytosis and MCAS:

• Wearing protective clothing: Wearing loose-fitting clothing made of natural fibers can help minimize skin irritation and reduce the risk of triggering mast cell activation.


• Carrying emergency medication: Individuals with severe symptoms or a history of anaphylaxis should carry an epinephrine autoinjector and any other prescribed emergency medications at all times.


• Seeking emotional support: Living with chronic conditions can be emotionally challenging. Connecting with support groups or seeking therapy can provide valuable emotional support.

It is important to note that treatment plans should be individualized and developed in collaboration with a healthcare professional experienced in Mastocytosis and MCAS. Regular follow-ups and adjustments to the treatment plan may be necessary to ensure optimal symptom management and overall well-being.