Karen Berger, PharmD
Karen Berger, PharmD, graduated from the University of Pittsburgh School of Pharmacy in 2001. She has worked in community pharmacies for over 17 years as a Pharmacist in Charge, staff, and floater pharmacist for a large chain. Currently, she is a pharmacist at an independent pharmacy in Northern NJ. She can be reached at email@example.com
She pulls out a note from her allergist, and sure enough it reads, “loratadine 10 mg: take one tablet 3 times daily.”
Mystery: Why is KJ taking an unusually high dose of loratadine?
Solution: Upon further conversation, KJ tells you that she has mast cell activation syndrome (MCAS). Mast cells, part of the immune system, react to foreign bodies/injury by releasing chemical mediators, such as histamine, when activated. In a healthy person, these chemicals protect and heal the body, but in a patient with MCAS, these chemicals are inappropriately triggered and released. Patients may be triggered by foods, exercise, chemicals, fragrances, stress, or other triggers, and often experience new triggers over time.
MCAS may affect many body systems and cause symptoms such as skin rashes (often severe), pain, gastrointestinal problems, mental health issues, and anaphylaxis, among others. MCAS can present along with Ehlers Danlos Syndrome (EDS), and/or Postural Orthostatic Tachycardia Syndrome (POTS).
Treatment is very individualized to the patient’s symptoms. Treatment often includes trigger avoidance, mast cell stabilizers, and/or high doses of antihistamines/H2 antagonists to block histamine from H1 and H2 receptors. Many patients take loratadine (or another H1 antagonist) along with ranitidine (or another H2 antagonist) to help combat mast cell activation.
Mast Cell Action. About MCAs. Mast Cell Action website. https://www.mastcellaction.org/. Accessed June 9, 2019