What are the treatment options for dry throat and thirst associated with Mast Cell Activation Syndrome (MCAS) besides antihistamines?

From the Guidelines

For dry throat and thirst associated with Mast Cell Activation Syndrome (MCAS) beyond antihistamines, staying well-hydrated with at least 8-10 glasses of room temperature water daily is essential, along with using alcohol-free mouthwashes, sugar-free lozenges or gum containing xylitol, and a saline nasal spray 2-3 times daily to maintain moisture in the nasal passages and throat. This approach is crucial as it directly addresses the symptoms by moisturizing the mucous membranes. Additionally, humidifiers in living spaces can add moisture to the air, reducing throat dryness 1. Mast cell stabilizers like cromolyn sodium (oral solution 100mg four times daily) or quercetin (500mg twice daily with food) may also be beneficial in reducing mast cell degranulation that contributes to these symptoms 1. It is also important to avoid known MCAS triggers such as alcohol, spicy foods, and extreme temperatures, as these can worsen throat dryness.

Some key considerations include:

• Using room temperature water for hydration to avoid triggering mast cells with cold water
• Avoiding substances that can trigger mast cell activation, such as certain foods or environmental factors
• The potential use of mast cell stabilizers under the guidance of a healthcare provider
• Maintaining a consistent environment to reduce triggers for mast cell activation

Given the information from the studies, particularly the most recent and highest quality study 1, the focus should be on managing symptoms through hydration, avoiding triggers, and potentially using mast cell stabilizers, all of which can help in reducing the frequency and severity of dry throat and thirst associated with MCAS.

From the FDA Drug Label

Cromolyn sodium inhibits sensitized mast cell degranulation which occurs after exposure to specific antigens. Cromolyn sodium acts by inhibiting the release of mediators from mast cells.

The treatment options for dry throat and thirst associated with Mast Cell Activation Syndrome (MCAS) besides antihistamines may include cromolyn sodium.

• Cromolyn sodium can help alleviate symptoms by inhibiting mast cell degranulation and the release of mediators. However, the label does not directly address dry throat and thirst, therefore, no conclusion can be drawn about its effectiveness for these specific symptoms 2.

From the Research

Treatment Options for Dry Throat and Thirst in MCAS

Besides antihistamines, treatment options for dry throat and thirst associated with Mast Cell Activation Syndrome (MCAS) include:

• Medications that target mast cells, such as sodium cromolyn 3
• Inhibition of mediator synthesis, such as aspirin or zileuton 3
• Mediator release inhibition, such as sodium cromolyn 3
• Anti-IgE therapy 3
• Corticosteroids for prolonged episodes of mast cell activation 3
• Management of comorbid psychiatric illness and nutritional deficits 4

Management of MCAS Symptoms

Management of MCAS symptoms, including dry throat and thirst, involves:

• A comprehensive treatment plan that includes medications that target mast cells 4
• Treatments for associated conditions, including autonomic dysfunction 4
• Management of comorbid psychiatric illness and nutritional deficits 4
• Diagnostic testing to assess for elevations in mast cell mediators during symptoms and to rule out other conditions 4

Specific Treatments for Dry Throat and Thirst

Specific treatments for dry throat and thirst in MCAS are not well-studied, but may include:

• Continuous diphenhydramine infusion, which has been shown to improve anaphylactic reactions and decrease hospital readmission in a patient with MCAS 5
• Imatinib, which has been shown to improve quality of life in a patient with MCAS, even in the absence of the KIT-D816V mutation 5