Histamine and Mast Cell Medication & Treatment…What the Hist? Part 2
Disclaimer: I am not a medical professional. All information is based on my personal experience and collation and summary of online resources.
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H1 blockers
The most accessible and widely used treatment for histamine sensitivity is H1 blockers also known as antihistamines generally available over the counter.
The strongest most recent formulations are
Zyrtec & Xyzal
Also commonly used are
Claratin & Allegra
The most frequent "rescue" med (aka a medication used to stop a reaction) is
Benadryl
Which also comes as IV Benadryl
Many people with histamine sensitivity take above the labeled dose and/or multiple H1 blockers. It is important if you do so to check for drug interactions and to consult your doctor.
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H2 Blockers
For most people H1 blockers alone are insufficient because they only block one histamine receptor. To block both an H1 and H2 blockers must be combined.
H2 blockers are often sold OTC and marketed as antiacid medication. They include:
Pepcid (famotidine)
Tagamet (cimetidine)
Nizatidine
H2 blocker withdrawal is a documented phenomenon so be aware if you are going off H2 blockers a taper may be necessary to prevent side effects.
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Mast Cell Stabilizers
These drugs are generally marketed as asthma drugs and work to stop mast cells from degranulating. When a mast cell degranulates it releases histamine, tryptase, and other chemicals that cause the body to react or go into anaphylaxis.
The most common are
Ketotifen
Cromolyn Sodium
Some supplements like Quercetin are also mast cell stabilizers.
One way to tell whether you have a problem with mast cell activation (MCAS/MCAD) as opposed to histamine breakdown is whether you respond well to mast cell stabilizers.
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Singulair
The slides above and past version of this post incorrectly listed Singulair as a mast cell stabilizer. It is not. It is a leukotrine receptor antagonist or LTRA.
Leuoketrines are a mast cell mediator active in asthma and MCAS/D and singulair’s on label use is for aathma.
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Xolair / Omalizumab
Xolair is a biologic approved to treat idiopathic ucarteria and asthma. It works by binding to IgE in the body which stops that IgE from activating mast cells. It can be extremely effective but does not work for everyone. It is also the most expensive option and must be administered in a doctor's office the first time due to risk of anaphylaxis. Xolair is a subcutaneous injection with dosage ranging from 75ml to 300ml. Higher doses are generally used for hives and lower doses for asthma.
Note: Xolair forms bound IgE compounds which means total IgE levels will not be changed in laboratory test despite the fact-free serum IgE will decrease.
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Rescue Medication & Last Resort
These medications are used to stop someone who is in anaphylaxis from dying.
Epipen (Epinephrine)
Benadryl
Amphetamines
Steroids
There are also medications that can help histamine patients but are unideal due to side effects and risk of addiction primarily
steroids and Benzodiazepenes
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Supplements
There are many supplements used to treat mast cell and histamine intolerance. But the most important are
Quercetin a low-risk mast cell stabilizer, also found in apples and stinging nettle
And
DAO an enzyme our body produces to break down histamine. DAO can be taken in pill form extracted from animal kidneys. It is taken before meals to help break down the histamine released by food. There is now a vegan option available however its efficacy is less well-known. This supplement can be quite expensive but is a game-changer for many.
Other supplements include:
NAC
Vitamin C
Reservetrol
Zinc
As well as many other general anti-inflammatory supplements.
Note that many supplements contain the same active ingredients for example a stinging nettle supplement and quercetin have the same active effect.
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Immunotherapy
In some patients addressing diseases that developed before MCD / HIT such as ME, chronic lyme, and autoimmune disease can lead to improvement.
LDN or low-dose naltrexone is a very helpful inflammatory and immuno modululating drug.
IVIG is sometimes used in MCAS however it must be run very slowly and carefully as histamine sensitivity can lead to greater risk of infusion reactions. IVIG can also cause hives and allergic reactions including anaphylaxis.
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Stress management
Stress is a massive trigger for histamine release. Meditation and stress management is extremely important for histamine-sensitive patients. Managing histamine sensitivity is stressful so it can be extremely helpful to see a therapist specializing in chronic illness. ACT and mindfulness therapy can be especially useful.
In some cases use of psychiatric medication such as an SSRI or anti-anxiety drug may be helpful.
It is important to implement stress management whenever you are identifying triggers. Otherwise, it can form a vicious cycle of anxiety and reactions. See part 5 for more.
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Diet & Environment
A low histamine diet and reducing exposure to chemicals and fragrance can greatly help to reduce symptoms. However, the goal of treating histamine intolerance should not just be to reduce symptoms. Ideally, you should attempt to work with your doctors to find a balance between treatment and trigger avoidance.
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Part 2: Treatments
MCAS, MCAD, MCS, HIT, chronic Hives, asthma the world of mast cell activation and histamine intollerance is big and confusing. Mast Cell issues are a common commorbidity to Myalgic Encephalomyelitis or MECFS and related complex Chronic Illness. Yet the factual information about these diseases is often conflicting and difficult to decipher.
This post provides a brief overview of the most common treatments for mast cell and histamine disorders, primarily focusing on treatments for mast Cell Activation Syndrome and multiple chemical sensitivity.
The goal of these treatments is dual. To reduce symptoms and increase tolerance. Medications are the primary way of increasing tolerance. Therefore while trigger avoidance is a helpful tool, receiving medical care from a doctor who can guide medication management is also essential especially if your condition is severe.
People with MCS may struggle greatly to introduce new drugs and may react to fillers and dyes within medication. A compounding pharmacy may be able to provide medications without dyes, fillers, or colored capsules. These pharmacies are also the only way to access certain mast cell treatments like cromolyn sodium and ketotifen. When treating mast cell patients it is important to always introduce 1 change at time with waiting periods so that any adverse reactions can be identified. Go low and go slow. Never discontinue medications without the supervision of a doctor as this can trigger a severe reaction. This includes for purposes of blood or urine testing (if necessary your doctor will help you do this safely)
Remember, it can take months or years to find the right balance of medications that work for you.
This post cannot begin to fully cover mast cell treatment. For much more detailed information please see my primary source for this post, the amazing blog The Mast Attack. A good place to start is The Mast 107 a collection of the 107 most common questions about mast cell disease.
