Mast cell medications: Everything but antihistamines

The following medications listed are available in oral, intramuscular or intravenous formulation. Not all medications are available in the US or Europe. Topical and inhaled medications are not included in these lists.

Mast cell stabilizers interfere structures on the cell membrane required for degranulation and thus prevent the release of granule contents, including histamine.

Mast cell stabilizers
Cromolyn sodium/ Cromoglicic acid/ Nedocromil
Ketotifen
Omalizumab*
Quercetin
*mechanism unclear

 

Beta-2 adrenergic agonists cause smooth muscles to relax, which allow airways to open. These are used almost exclusively in asthma and pulmonary disease, which a secondary use in controlling uterine contractions in labor.

Beta-2 adrenergic agonists
Albuterol
Terbutaline

 

Leukotriene receptor antagonists work by interfering with the function of leukotrienes by blocking the CysLT1 receptor. Leukotrienes are heavily involved in airway reactivity and inflammation.

Leukotriene receptor antagonists
Montelukast
Pranlukast
Zafirlukast

 

5-lipoxygenase inhibitors prevent leukotrienes from being made.

5-lipoxygenase inhibitor
Curcumin
St. John’s Wort
Zileuton

 

Corticosteroids interfere with the activity of mast cells and production of mast cell mediators.

Mast cell stabilizers
Budesonide*
Dexamethasone
Hydrocortisone
Prednisone
Prednisolone
*taken orally, with effects local to the GI tract

 

Proton pump inhibitors reduce the production of gastric acid and treat heartburn, nausea and reflux. This can also be achieved by H2 antihistamines and for this reason, the two classes are often confused. The following medications, which are taken often by mast cell patients, have no known antihistamine effect. They can safely be taken with H2 antihistamines and help many mast cell patients, but it is important to clarify that they are NOT antihistamines.

Proton pump inhibitors
Dexlansoprazole
Esomeprazole
Ilaprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole