Skip to main content
. 2021 Oct 19;22(20):11270. doi: 10.3390/ijms222011270

Table 2.

Medical Management of Mast Cell Disorders.

Drug Class Medication and Dosing Primary Indication and Comments
H1-receptor
antagonist 		Long-acting:

  • Fexofenadine (60–180 mg orally once or twice/day)

  • Cetrizine (5–10 mg orally once or twice/daily)

  • Loratidine (10 mg orally once daily)


Short-acting:

  • Diphenhydramine (25–50 mg orally or parenterally every 6-8-h as needed)

  • Hydroxyzine (25 mg orally every 6-h as needed)

 Histamine-related symptoms (i.e., flushing, pruritis)
H2-receptor
antagonist 		Ranitidine (150 mg orally, twice/day)
Famotidine (10 mg orally twice/day)		 Gastrointestinal symptoms
Proton-Pump
Inhibitor (PPI) 		Omeprazole (20–40 mg orally daily
Pantoprazole (20–40 mg orally daily)		 Gastrointestinal symptoms
Leukotriene
receptor antagonist 		Montelukast (10 mg orally daily
Zafirlukast (20 mg orally daily)		 Histamine-related symptoms (i.e., flushing, pruritis)
Mast cell stabilizer Cromolyn sodium (four times a day maximum daily dose 40 mg/kg/day) Gastrointestinal symptoms
Histamine-related symptoms (i.e., flushing, pruritis)
Non-steroidal anti-inflammatory drug (NSAID) Aspirin (variable dosing) Histamine-related symptoms (i.e., flushing, pruritis)
Anti-IgE
monoclonal
antibody 		Omalizumab (150–300 mg administered subcutaneously every 2–4 weeks) Histamine-related symptoms (i.e., flushing, pruritis, recurrent anaphylaxis) not responsive to conservative measures
Immediate administration for anaphylaxis Epinephrine (0.3–0.5 mg intramuscularly every 5–15 min in the lateral thigh) Anaphylaxis
Cytoreductive therapy Interferon-α (IFN-α)

  • (Starting dose of 3 million units subcutaneously three times weekly can be increased to 3–5 million units up to 5 times weekly)


Cladribine (2-CdA)

  • (5 mg/m2/day or 0.14 mg/kg/day as a 2-h infusion for 5 days. Up to 6 cycles every 4–8 weeks)

 IFN-α: often co-administer with prednisone to improve tolerability
Flu-like syndrome
2-CdA: myelosuppression and lymphopenia common. Prophylaxis for Pneumocystis jirovecii infection needed

Abbreviations: mg, milligrams; PO, per oral; BID, twice daily; PRN, as needed; QID, four times daily; kg, kilograms; SQ, subcutaneous; IM, intramuscular; MU, million units.