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Triple Therapy Anti-Histamine Trial

Getting a tryptase test and getting it done right can be quite the hurdle. Instead, you can try the MCAS triple therapy protocol.

triple-therapy-anti-histamine-trial

If, after 2 weeks, you don’’t get a substantive improvement, you are unlikely to have significant MCAS.

  1. Sedating antihistamine (e.g., Benadryl, 6.25-50) at bedtime; also helps sleep
  2. Non-sedating antihistamine (e.g., Aerius, Claritin, etc.) at double the recommended dose on the package.
  3. Famotidine (Pepcid) 40 mg in the morning at double the recommended dose on the package.

Note:

  • Add the above medications one at a time to make sure you tolerate them
  • With the Benadryl, start with 6.25 mg at bedtime and increase, as tolerated, up to 50 mg. Once you know that you tolerate Benadryl and find your optimal dose, stop it and try the non-sedating antihistamine.
  • Take one tablet of the non-sedating antihistamine in the morning, if you tolerate it, take another at bedtime. Once you know that you tolerate nonsedating antihistamine and find your optimal dose, stop it and try the famotidine.
  • Take famotidine 40 mg in the morning, if you tolerate it, take another 40 mg at bedtime. Once you know that you tolerate famotidine and find your optimal dose, stop it. You are now ready for the therapeutic trial of triple therapy for MCA.
  • Start all three medications at their optimal dose for 2 weeks and cross your fingers!

Taper Protocol

The next step is to taper the medications, one at a time, to find the minimum doses
which keep the symptoms at bay. Some patients only take the medication as needed, rather than regularly.

We suggest tapering the sedating antihistamine (Benadryl) first. The dose can be tapered by 6.25 mg a week and be discontinued if symptoms do not get worse.
Next, We suggest tapering the H2 blocker (famotidine). The dose can be halved once a week and discontinued if symptoms do not get worse.

Finally, the non-sedating antihistamine: (e.g., Aerius, Claritin, etc.) can be tapered. The dose can be halved once a week and discontinued if symptoms do not get worse.

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