Medications

Browse medicines in the published stepwise sequence, with emergency, trigger-specific, emerging or refractory, and local-route options kept in separate groups. Every card keeps how the treatment relates to mast cells, the types of studies cited, the conditions studied and regulatory approval separate.

Nothing here is approved for MCAS, and almost nothing has been tested in it. Most entries draw their studies from another condition or from laboratory work; the few direct MCAS reports are uncontrolled. Each card says which. The numbered groups report a published stepwise sequence. Emergency treatment appears before it; trigger-specific, emerging or refractory, and local-route treatments each sit in their own group. Everything else remains outside the sequence. Within a group, entries follow the order the review itself describes where it describes one. Where it does not, an internal direct-study rank sets browsing order; it is not a usefulness or treatment score. Every card shows the literal facts behind that order and states which conditions are actually approved or trialled.

34 entries. No dosing, and no claim that anything here works. How this is decided.

Emergency intervention — time-critical acute treatment, not a maintenance step

1. H1 antihistamines — described as the initial treatment, with second-generation agents prioritised over first

2. H2 antihistamines — described as add-on therapy where episodes involve gastrointestinal symptoms

3. Leukotriene receptor antagonists — the next class described; in Canada montelukast is the only available option

4. Cromolyn — described for persistent gastrointestinal symptoms despite H1 and H2 blockade

5. Ketotifen — described for patients not controlled on high-dose second-generation H1 antihistamines

6. Aspirin — described as limited evidence, for persistent episodes despite H1 blockade

7. Oral corticosteroids — described for frequent episodes, with use limited by adverse effects

8. Omalizumab — described for severe recurrent reactions despite the preceding treatments

Trigger-specific treatment — directed at a defined sensitization or trigger

Emerging / refractory evidence — direct reports or surveys outside the routine stepwise sequence

Local-route symptom treatments — route-specific products, not systemic MCAS interventions

Outside that sequence — not part of the stepwise approach the review describes