Commonly used basic supportive therapy and emergency therapy strategies for patients with SM
| Drug/therapy . | Recommended indication . | Schedule . |
|---|---|---|
| HR1 antagonists* | Mediator-related symptoms | Continuous orally |
| HR2 antagonists* | Gastrointestinal tract symptoms | Continuous orally |
| Proton pump inhibitors | Gastrointestinal tract symptoms | As needed orally |
| Cromolyn sodium or other MC stabilizers | Gastrointestinal tract symptoms | As needed orally |
| Glucocorticosteroids | Mediator-related symptoms and anaphylaxis not responsive to HR1/HR2 antagonists and MC-stabilizing agents | Short courses orally or intravenously |
| Bisphosphonates* | T score < −2, osteolyses | Continuous orally or intravenously |
| Allergen immunotherapy† | Allergy (IgE+)† | Lifelong for venom |
| Epinephrine pen | Anaphylactic shock | Emergency, subcutaneously |
| Drug/therapy . | Recommended indication . | Schedule . |
|---|---|---|
| HR1 antagonists* | Mediator-related symptoms | Continuous orally |
| HR2 antagonists* | Gastrointestinal tract symptoms | Continuous orally |
| Proton pump inhibitors | Gastrointestinal tract symptoms | As needed orally |
| Cromolyn sodium or other MC stabilizers | Gastrointestinal tract symptoms | As needed orally |
| Glucocorticosteroids | Mediator-related symptoms and anaphylaxis not responsive to HR1/HR2 antagonists and MC-stabilizing agents | Short courses orally or intravenously |
| Bisphosphonates* | T score < −2, osteolyses | Continuous orally or intravenously |
| Allergen immunotherapy† | Allergy (IgE+)† | Lifelong for venom |
| Epinephrine pen | Anaphylactic shock | Emergency, subcutaneously |
HR indicates histamine receptor; and IgE, immunoglobulin E.
These drugs are also prescribed as prophylactic therapy in patients with SM. Examples of commonly used HR1 and HR2 antagonists include: long-acting HR1 antagonists fexofenadine, cetirizine, or loratadine, which may be supplemented with short-acting drugs, such as diphenhydramine or hydroxyzine (the latter have sedating effects); HR2 antagonists commonly used include ranitidine, famotidine, or cimetidine.
Most commonly recommended for patients with hymenoptera venom allergy.