Montelukast and zafirlukast block the effects of leukotriene C4 (LTC4) and zileuton blocks LTC4 production, so these reduce wheezing and abdominal cramping.Ĭorticosteroids are helpful for edema, hives and wheezing but should only be used as a last resort. Treatment with histamine type 2 receptor blockers, such as ranitidine or famotidine, can be helpful for abdominal pain and nausea.Īspirin blocks production of prostaglandin D2 and can reduce flushing. Second generation antihistamines, including loratadine, cetirizine and fexofenadine, are preferable due to fewer side effects. The treatment of acute episodes should follow the recommendations for treatment of anaphylaxis, starting with epinephrine, if indicated by the severity of symptoms.Īntihistamines, such as the first generation histamine type 1 receptor blockers diphenhydramine and hydroxyzine, can be effective for itching, abdominal discomfort and flushing, but their use may be limited by side effects (sleepiness). Lack of response to these treatments suggests that MCAS is not present. The immediate goal is to provide relief for the patient. The goals of treatment are both diagnosis and patient relief. Since these are not standard laboratory tests, patients should work with their local allergist who can communicate with emergency and lab personnel to assure they are ordered and completed in a timely fashion. The urine tests are performed on a 24 hour collection of urine that is started immediately. Total serum mast cell tryptase should be drawn between 30 minutes and two hours after the start of an episode, with baseline level obtained many days later. Increases in serum mast cell tryptase and in urine levels of N-methylhistamine, 11B -Prostaglandin F2α (11B-PGF2α) and/or Leukotriene E4 (LTE4) are the only useful tests in diagnosis of MCAS. Mast cells are known to produce many molecules that cause inflammation, but only a few mediators or their stable breakdown products (metabolites) have been found reliably elevated in episodes of MCAS and measurable in commercial laboratory tests. Gastrointestinal tract symptoms: diarrhea, nausea with vomiting and crampy abdominal pain.
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