Mastocytosis: Understanding Treatment Options and Symptom Management

Overview

Mastocytosis is a rare disorder of abnormal mast cell accumulation. No cure exists, but symptoms can be effectively managed.

H1 Antihistamines: Cetirizine, loratadine, fexofenadine – first-line for itching, flushing, GI symptoms.
H2 Antihistamines: Famotidine, ranitidine – for GI acid hypersecretion.
Mast Cell Stabilizers: Cromolyn sodium (oral) – prevents mediator release; helpful for GI/bone symptoms.
Corticosteroids: Short courses for flares; topical for cutaneous lesions.
Leukotriene Antagonists: Montelukast – adjunct for respiratory/GI symptoms.
Epinephrine Auto-injector: Mandatory for anaphylaxis risk.
Tyrosine Kinase Inhibitors: Midostaurin, avapritinib – for advanced systemic mastocytosis (SM).
Surgery: Rare; for complications (e.g., massive splenomegaly, symptomatic bone lesions).

Identify/avoid triggers: heat, stress, alcohol, NSAIDs, certain foods, insect stings.
Wear medical alert ID.
Regular follow-up with allergist/immunologist or hematologist experienced in mastocytosis.

Cutaneous mastocytosis (children) often resolves by adolescence. Systemic forms are chronic but manageable with modern therapies.