A multifaceted approach to treatment
The best treatment for mast cell activation syndrome is multifaceted, said Dr. Hamilton. The first step is to recommend medications that target mast cells, which are exceptionally effective. These medications include type 1 and type 2 antihistamines, cromolyn, ketotifen, and leukotriene antagonists. Medications to alleviate symptoms are another component of treatment. Dietary modification is beneficial, and social and psychological support may be needed, as well.
Patients often will ask which foods they can eat without triggering symptoms. In a survey of 420 patients with a mast cell disorder, half of respondents reported having an “allergy” to a food or beverage (J Allergy Clin Immunol Pract. 2014;2[1]:70-6). Although not all of these patients have true allergies, they have symptoms in response to certain foods, said Dr. Hamilton. Milk, dairy products, red meat, and wheat are common triggers for these patients. But for some patients, a food may not cause symptoms consistently. “It has more to do with [the patient’s] state of reactivity at the time of eating than the actual foods [that he or she] eats,” said Dr. Hamilton.
Dietary modifications can relieve symptoms for patients with mast cell activation syndrome. Food diaries can be beneficial because they prompt patients to observe what they eat and which foods cause symptoms. An important principle is to eliminate triggers, allergies, and food sensitivities.
One way for patients to take the initiative in their treatment is for them to prepare their own food as often as possible. They should avoid restaurants and strive to eat a balanced, nutritious diet, said Dr. Hamilton. A nutritionist can provide guidance in this regard. “In general, I tell [patients] to avoid sugars, chemicals, processed foods, preservatives, and alcohol,” said Dr. Hamilton. “These things in our Western diet can be toxic to a lot of patients.” A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can benefit patients with symptoms similar to those of IBS, he added.
Physicians who treat patients with mast cell activation syndrome still have unmet needs, however. Researchers need to identify additional objective biomarkers of the syndrome, said Dr. Hamilton. Research also should be directed toward recognizing disease subtypes such as familial hypertryptasemia, a subset of mast cell activation syndrome, he added. Finally, patients need more safe and effective therapies, as well as optimized diet therapy.