What are common supplements taken for Mast Cell Activation Syndrome (MCAS)?

Common Supplements for Mast Cell Activation Syndrome (MCAS)

The most effective supplements for managing MCAS include H1 antihistamines, H2 antihistamines, and mast cell stabilizers like cromolyn sodium, which should be used as the foundation of MCAS management before considering other supplements. 1

First-Line Supplements and Medications

Antihistamines

• H1 Antihistamines:

  • Non-sedating options (preferred): Fexofenadine, cetirizine
  • Can be increased to 2-4 times standard dose for better symptom control
  • Target symptoms: flushing, pruritus, urticaria, tachycardia, dermatologic manifestations 1

• H2 Antihistamines:

  • Options: Famotidine, ranitidine, cimetidine
  • Should be used concurrently with H1 antihistamines for enhanced effect
  • Target symptoms: abdominal discomfort, gastrointestinal symptoms, cardiovascular symptoms 1

Mast Cell Stabilizers

• Cromolyn Sodium:
  • Dosing: Start low and gradually increase to 200mg 4 times daily (before meals and at bedtime)
  • Particularly effective for gastrointestinal symptoms (diarrhea, abdominal pain, nausea)
  • May also benefit neuropsychiatric manifestations 1
  • Available as oral solution, nasal spray, or topical formulation 2

Second-Line Supplements and Medications

Anti-inflammatory Options

• Aspirin:

  • Consider for patients with flushing and hypotension, especially those with increased urinary prostaglandin levels
  • Dosing: May require up to 650mg twice daily
  • CAUTION: Contraindicated in patients with allergic reactions to NSAIDs
  • CAUTION: May trigger mast cell activation in some patients 2, 1

• Leukotriene Receptor Antagonists (e.g., montelukast):

  • Useful for management of skin and gastrointestinal symptoms refractory to other treatments 2

Biologic Therapies

• Omalizumab:
  • Consider for antihistamine-resistant symptoms
  • Particularly effective for recurrent anaphylaxis and skin symptoms
  • Less effective for gastrointestinal, musculoskeletal, and neuropsychiatric symptoms 2, 1

Natural Supplements with Evidence for Mast Cell Stabilization

Several flavonoids and plant compounds have shown mast cell stabilizing properties in research studies:

• Quercetin:

  • Natural flavonoid with mast cell stabilizing properties
  • Has shown improvement in allergic rhinitis symptoms in clinical trials 3

• Vitamin D:

  • May help reduce mast cell activation
  • Has shown improvement in allergic symptoms in randomized controlled trials 3

• Resveratrol:

  • Demonstrated effectiveness in suppressing mast cell mediator release
  • Has shown improvement in allergic rhinitis symptoms in clinical trials 3

• Curcumin:

  • Shows anti-inflammatory effects on mast cells
  • Has shown improvement in allergic symptoms in clinical trials 3

Emergency Management Supplements

• Epinephrine Auto-injectors:
  • All MCAS patients should carry two epinephrine auto-injectors
  • Essential for those with history of systemic anaphylaxis or airway angioedema 1

Practical Considerations

Timing and Administration

• Adjust timing of medications to ensure highest drug levels when symptoms are anticipated
• For nighttime symptoms, consider adding a sedating antihistamine (e.g., hydroxyzine 10-25mg) to a non-sedating daytime regimen 1

Cautions with Supplements

• Many dietary supplements contain multiple ingredients with undisclosed source/purity
• Some may have biological effects or interact with other supplements or medications
• When using natural supplements, look for products that disclose complete list of active ingredients, their source, purity, and exact concentration 4

Special Populations

• For patients with moderate renal impairment, reduce cetirizine dose by half
• For severe renal impairment, avoid cetirizine and levocetirizine
• Use caution with antihistamines metabolized by the liver in patients with hepatic impairment 1

Monitoring and Follow-up

• Regular assessment of symptom control and medication efficacy is crucial
• Periodic laboratory evaluation during symptomatic episodes helps guide treatment adjustments
• A multidisciplinary approach involving allergists, immunologists, and other specialists is essential for comprehensive management 1