From the Guidelines
Morning nausea in mastocytosis is best managed with a combination of H1 antihistamines, such as cetirizine (10mg) or fexofenadine (180mg), and H2 blockers, like famotidine (20mg twice daily), taken before bed or immediately upon waking, as recommended by the most recent guidelines 1. This approach is based on the understanding that mast cells release histamine and other inflammatory mediators that can irritate the stomach lining and trigger the vomiting center in the brain, with symptoms often worsening in the morning due to natural fluctuations in histamine levels.
To further manage morning nausea, it is advisable to:
- Avoid triggers like alcohol, spicy foods, and certain medications before bedtime
- Eat a small, bland snack before sleep and keep plain crackers by the bed to eat before getting up, which can help stabilize blood sugar and dilute stomach acid
- Stay hydrated and rise slowly from bed to reduce symptoms
- Consider additional medications like cromolyn sodium (200mg four times daily) to stabilize mast cells or ondansetron for severe nausea, as prescribed by a doctor
The use of cromolyn sodium has been shown to be effective in managing gastrointestinal symptoms, including nausea and vomiting, in patients with mastocytosis 1. However, the most recent and highest quality studies support the primary use of H1 and H2 antihistamines as the first line of treatment for managing morning nausea in mastocytosis 1.
It is essential to follow the guidance of a healthcare professional and to be aware of the potential side effects and interactions of any medications prescribed. The management of mastocytosis and its symptoms requires a multidisciplinary approach, and referral to specialized centers with expertise in mastocytosis is recommended for comprehensive care 1.
From the Research
Relationship Between Mastocytosis and Morning Nausea
- Mastocytosis is a disorder characterized by an abnormal increase in tissue mast cells, which can lead to various symptoms, including gastrointestinal issues 2, 3, 4.
- Nausea is a common symptom of mastocytosis, affecting approximately 70%-80% of patients with the disorder, although it is not specifically stated as morning nausea 4.
- The symptoms of mastocytosis can be triggered by various factors, including spontaneous triggers or precipitated by situations, stimuli, and exposures, which may contribute to nausea at any time of day, including morning 4.
- While the studies do not specifically address morning nausea, they do mention that mastocytosis symptoms can include nausea, vomiting, abdominal pain, and diarrhea, which can occur at any time 2, 3, 4.
- Treatment for mastocytosis aims to reduce the effects of mast cell mediators, which may help alleviate nausea and other symptoms, but the timing of these symptoms, such as morning nausea, is not specifically addressed 5, 2, 3, 6.