SIGHI Medication Manual — Reference Summary
Source: SIGHI Medication Manual (Preview), version 2019-01-03. Author: Heinz Lamprecht, MSc. Translated by Dr. med. Matthew Chaney. Publisher: SIGHI.
This is a summary of the table of contents and key sections visible in the preview. The full manual is available to SIGHI members. This note captures the structural overview and key therapeutic strategy for reference.
Therapeutic Strategy for MCAD
Treatment has two pillars: avoiding triggers and medication.
Medication subdivides into:
- Mast cell stabilizers (reduce mediator release)
- Mediator inhibitors (block effects of released mediators)
- Degradation promoters (accelerate histamine breakdown)
There is no curative therapy. Treatment manages symptoms for life and reduces frequency of acute reactions. The mainstay is identifying and avoiding triggers; medication supports but cannot replace trigger avoidance long-term.
Every MCAD patient has an individual constellation of symptoms with individual severity that fluctuates over time. Therapy must be individually adapted.
Basic Therapy (Chronic Phase)
See also: H1 Antihistamines, H2 Antihistamines, Mast Cell Stabilizers, Cromolyn Sodium, Ketotifen
The manual describes a stepwise basic therapy. Many patients need up to 4-6x the usual daily dose of antihistamines on a long-term basis.
Acute Phase Management
For non-alarming symptom increases: increase dosage of basic medication and/or symptomatic supplemental therapy up to maximum permissible daily amount. Prefer agents with rapid onset. Slow-acting agents (e.g. ketotifen) don’t need dose adjustment for one-off events.
Short-term options:
- Benzodiazepines (flunitrazepam per os, max 3-4 days) — inhibit mediator release from mast cells
- Vitamin C 750mg IV in glucose solution (severe cases, 3-4 days)
Medication Categories Covered
Prescription Medications
- H1 Antihistamines — bilastine, cetirizine, clemastine, desloratadine, dimenhydrinate, dimetindene, diphenhydramine, fexofenadine, hydroxyzine, ketotifen, levocetirizine, loratadine, rupatadine
- H2 Antihistamines — ranitidine (and note: this has been withdrawn in many markets)
- Mast Cell Stabilizers — cromoglicic acid/sodium cromoglicate, ketotifen
- NSAIDs — ibuprofen, dexibuprofen, acetylsalicylic acid, etoricoxib, celecoxib (marked with △ = caution)
- Leukotriene Inhibitors — montelukast, zafirlukast
- Analgesics — paracetamol/acetaminophen (caution: may increase bronchial constriction)
- Proton Pump Inhibitors
- Cannabinoids — THC, CBD, palmitoylethanolamide (PEA)
- Opiates (marked with △ = caution)
- Psychiatric Medications — antidepressants (doxepin), neuroleptics, benzodiazepines
- Immunosuppressants — glucocorticoids, azathioprine, methotrexate
- Anti-IgE — omalizumab
- Tyrosine Kinase Inhibitors — imatinib, masitinib, midostaurin, etc.
- Cytoreductive — interferon-α, cladribine, hydroxyurea
Medical Devices
- Clinoptilolite/zeolite — SIGHI is skeptical; their own 6-person trial found no effect
Foods for Special Medical Purposes
- DAO supplements — DAOSIN; prophylactic only, for dietary histamine only
- Probiotics — Lactopia Probio Histamed
Nutritional Supplements
- Vitamin C — 100-1000mg/day, spread across doses of max 200mg each. Lowers histamine but weak DAO inhibitor. Buffered forms (magnesium/calcium ascorbate) better tolerated.
- Vitamin D3 — vitamin D receptors on mast cells; D needed for mast cell stability; D deficiency → mast cell activation
- Zinc
- Natural mast cell stabilizers — chondroitin sulfate, flavonoids (quercetin with △ caution), curcumin, stilbene derivatives, ellagic acid
- Selenium
Symptom-Specific Treatments Referenced
The manual maps specific symptoms to medication options:
- Pain/headache — H1-AH dose increase, ibuprofen/dexibuprofen, etoricoxib
- Endometriosis pain — PEA, cromoglicic acid
- GI: acid reflux/heartburn — H2-AH, PPI
- GI: diarrhea — colestyramine, montelukast, psyllium husks, ondansetron
- GI: nausea — benzodiazepines, ondansetron
- Histamine-rich food sensitivity — DAO supplements
- Insomnia — benzodiazepines (triazolam, oxazepam)
- Depression — doxepin
- Anxiety/panic — benzodiazepines (lorazepam, alprazolam, clonazepam)
- Asthma — leukotriene antagonists
- Bladder pain/interstitial cystitis — H1-AH, H2-AH, pentosan polysulphate
Premedication Before Medical Interventions
The manual includes extensive guidance for premedication before surgery/anesthesia, dental work, contrast medium examinations, and vaccinations. This is critical safety information for MCAS patients. Key point: inform all medical professionals about MCAS and provide them with the premedication protocol.
Incompatible Active Substances
The manual includes an annex listing active pharmaceutical ingredients that are incompatible for MCAS patients. This is separate from the food list and covers medication excipients as well as active ingredients.
Where to Get the Full Manual
Available to SIGHI members at www.mastzellaktivierung.info. The preview covers the table of contents and selected sections.