MCAS Treatment
How to Treat Mast Cell Activation Syndrome?
MCAS treatment focuses on reducing mast cell activity, preventing flare-ups and relieving symptoms. The first step is identifying and avoiding triggers whenever possible. Medications can also help stabilize mast cells ─ preventing them from releasing excessive chemical mediators.
These can include antihistamines (both H1 and H2 blockers) and other mast cell stabilizers like cromolyn sodium, nedocromil, lodoxamide.
Mast cell stabilizers come in various forms, including oral solutions, nasal sprays, and eye drops, depending on the condition being treated.
In addition to avoiding triggers and taking medications, MCAS treatment also involves making lifestyle adjustments — such as dietary changes. Stress management, adequate sleep, and minimizing exposure to environmental irritants can also help reduce symptom flare-ups.
Avoiding Triggers in Treatment for MCAS
Dietary
Dietary management also plays a key role in MCAS treatment. Many patients find relief by following a low-histamine or anti-inflammatory diet. Eliminating common triggers such as aged cheeses, fermented foods, alcohol, and processed additives can reduce mast cell activity and calm inflammation.
Environmental
An important part of treatment for MCAS involves creating an environment free of any possible triggers. Many patients find relief by using HEPA air purifiers, removing mold sources, and creating fragrance-free living spaces. Even small adjustments like switching to hypoallergenic detergents or maintaining consistent indoor temperatures can reduce the frequency of flares.
Medications to Stabilize Mast Cells
Medications play a central role in mast cell activation syndrome treatment. Antihistamines are often the first line of therapy. H1 blockers (like cetirizine, fexofenadine, or loratadine) target skin and respiratory symptoms, while H2 blockers (such as famotidine) help gastrointestinal issues and systemic reactions.
If symptoms continue, mast-cell stabilizers (such as, cromolyn sodium or ketotifen) can help reduce the release of chemicals that trigger symptoms.
Cromolyn can be particularly effective for gastrointestinal symptoms, while Ketotifen can help with neurological and systemic reactivity.
Leukotriene inhibitors, like montelukast or zileuton, and other immune modulators may also be used to treat more severe cases of MCAS. These drugs target a different inflammatory pathway and can ease breathing or heart-related symptoms.
Supporting Gut and Immune Health
Gut health is especially important in the treatment of mast cell activation syndrome, since 70% of mast cells are found in the gastrointestinal tract. DAO (diamine oxidase) ─ an enzyme that helps break down histamine in the gut ─ can be beneficial in treating MCAS. Taken just before meals, it can reduce post-meal flushing, headaches or heart palpitations by helping the body clear histamine.
Other therapies include supplements like quercetin, luteolin, curcumin (from turmeric) and Resveratrol, which help prevent mast cells from releasing inflammatory chemicals, such as histamine and cytokines.
Low-histamine probiotics can also improve the gut microbiome and reduce systemic inflammation. Omega-3 fatty acids, vitamin D, and antioxidants like N-acetylcysteine (NAC) or alpha-lipoic acid further support immune balance, quiet overactive mast cells, and help the body clear histamine and inflammatory byproducts.
Note: The information presented on this page has been reviewed and approved by a member of our Medical Leadership Board.
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