Basic therapy (continuous oral combination therapy to reduce mast cell activity) | • H1-histamine receptor antagonist (to block activating H1-histamine receptors on mast cells; to antagonize H1-histamine receptor-mediated symptoms) • H2- histamine receptor antagonist (to block activating H2-histamine receptors on mast cells; to antagonize H2-histamine receptor-mediated symptoms) • Cromolyn sodium (stabilising mast cells) • Slow-release Vitamin C (increased degradation of histamine; inhibition of mast cell degranulation; not more than 750 mg/day) • If necessary, ketotifen to stabilise mast cells and to block activating H1-histamine receptors on mast cells |
Symptomatic treatment options (orally as needed) | • Headache⇒ paracetamol; metamizole; flupirtine • Diarrhea⇒ colestyramine; nystatin; montelukast; 5-HT3 receptor inhibitors (eg. ondansetron); incremental doses (50-350 mg/day; extreme caution because of the possibility to induce mast cell degranulation) of acetylsalicylic acid; (in steps test each drug for 5 days until improvement of diarrhea) • Colicky abdominal pain due to distinct meteorism ⇒ metamizole; butylscopolamine • Nausea⇒ metoclopramide; dimenhydrinate; 5-HT3 receptor inhibitors; icatibant • Respiratory symptoms(mainly increased production of viscous mucus and obstruction with compulsive throat clearing) ⇒ montelukast; urgent: short-acting ß-sympathomimetic • Gastric complaints⇒ proton pump inhibitors (de-escalating dose finding) • Osteoporosis, osteolysis, bone pain⇒ biphosphonates ([51]; vitamin D plus calcium application is second-line treatment in MCAD patients because of limited reported success and an increased risk for developing kidney and ureter stones; [52]) • Non-cardiac chest pain⇒ when needed, additional dose of a H2-histamine receptor antagonist; also, proton pump inhibitors for proven gastroesophageal reflux • Tachycardia⇒ verapamil; AT1-receptor antagonists; ivabradin • Neuropathic pain and paresthesia⇒ α-lipoic acid • Interstitial cystitis⇒ pentosan, amphetamines • Sleep-onset insomnia/sleep-maintenance insomnia⇒ triazolam/oxazepam • Conjunctivitis⇒ exclusion of a secondary disease; otherwise preservative-free eye drops with glucocorticoids for brief courses • Hypercholesterolemia⇒ (does not depend on the composition of the diet) therapeutic trial with HMG-CoA reductase inhibitors (frequently ineffective) • Elevated prostaglandin levels, persistant flushing⇒ incremental doses of acetylsalicylic acid (50-350 mg/day; extreme caution because of the possibility to induce mast cell degranulation) |