Hi Friend
Today I am discussing world of mast cell stabilisers, these are often the missing piece when treating patients for MCAS, we can use both medications and supplements.
What Is a Mast Cell Stabiliser and Why Does It Matter?
When we talk about treating MCAS, most people are familiar with antihistamines, the medicines that block the effects of histamine once your mast cells have already released it. Antihistamines are brilliant and absolutely have their place, but they are working downstream, mopping up the flood after it has already happened.
Mast cell stabilisers work at an entirely different level. Rather than blocking what mast cells release, they work to calm the mast cells themselves, making them less likely to degranulate and release their inflammatory mediators in the first place. Think of it this way. Antihistamines are the towels you reach for when the bath is overflowing. Mast cell stabilisers are what turn the tap down before the water gets out of control.
For many MCAS patients, combining both approaches gives the most comprehensive symptom control, which is why mast cell stabilisers form such an important part of a well-rounded treatment plan.
Prescription Mast Cell Stabilisers
Ketotifen
Ketotifen is one of the most widely used mast cell stabilisers in MCAS management and for good reason. It has a dual action, working both as a mast cell stabiliser and as an antihistamine, giving it a particularly useful role in an MCAS protocol. It is typically introduced gradually, starting at a low dose at night due to its sedating effects, before building up to a twice daily dose.
The sedation that ketotifen causes is one of the most commonly reported side effects, particularly when the morning dose is introduced. The good news is that for the majority of patients this settles considerably after the first two to three weeks as the body adjusts. Many patients actually find the sedating effect helpful initially, particularly if sleep disturbance is one of their symptoms.
Ketotifen in the UK typically requires a prescription from a specialist to a compounding pharmacy. This means it can be made to your exact specifications, including being free from dyes, gluten, dairy and soy, which is particularly important for MCAS patients who react to excipients. I regularly do this at the mend clinic.
Sodium Cromoglicate
Sodium cromoglicate, sometimes called cromolyn sodium, is one of the oldest and most established mast cell stabilisers available. It works by preventing mast cells from opening their calcium channels, which is the trigger mechanism that leads to degranulation and mediator release. In simple terms, it keeps the mast cells calm and contained.
For MCAS patients, sodium cromoglicate is particularly valuable for gut symptoms. When taken orally it is very poorly absorbed into the bloodstream, which means it works locally in the gastrointestinal tract rather than systemically. This makes it an excellent choice for patients who experience significant digestive symptoms including bloating, abdominal pain, diarrhoea, nausea, and food reactions.
Because it acts locally in the gut, sodium cromoglicate is exceptionally well tolerated and has very few systemic side effects, making it a good option even for very sensitive patients. As with ketotifen, it is important that your formulation is compounded to your specific requirements to avoid triggering excipients.
Low Dose Naltrexone (LDN)
Low Dose Naltrexone sits in a slightly different category but deserves its place in this discussion because of the way it modulates immune function and reduces neuroinflammation, both of which are central to MCAS. At the very low doses used in MCAS management, typically starting at 0.5mg and titrating slowly up to 4.5mg nightly, LDN works through a completely different mechanism to standard naltrexone.
At these doses, LDN transiently blocks opioid receptors for a short period, which triggers the body to upregulate its own natural endorphin and enkephalin production. These endogenous opioids have powerful anti-inflammatory and immune modulating effects. Additionally, LDN directly reduces microglial activation in the brain, which is the neuroinflammatory process that underlies many of the cognitive and neurological symptoms so common in MCAS, including brain fog, poor memory, and sensory sensitivity.
LDN requires a specialist prescription and must be compounded, as it is not available in standard low dose formulations commercially. The titration is slow, increasing by 0.5mg each week, and this gradual pace is important for tolerability. Some patients notice vivid dreams or mild sleep changes in the early weeks, which typically resolve as the dose increases.
One critical point to remember is that LDN must never be taken alongside opioid medications including codeine, tramadol, morphine, or oxycodone, as it will block their effect and can precipitate withdrawal symptoms.
We can manage this whole process, for appts book here
Next week we will discuss supplements which you can but over the counter that also acts as mast cell stabilisers. The exact combination of medications and supplements you need really depends on your baseline symptoms, response and side effects (if any).
I have a few remaining slots for my 1-1 appointments, if you are interested please book here
Stay well
