EMERGENCY RESPONSE PLAN for mast cell disorder patient:*

EPINEPHRINE IM 0.3cc of 1/1000 and repeat 3x at 5 minute intervals (0.1cc for children under 12)

BENADRYL (generic diphenhydramine) 25-50 mg (12.5-25 for children under 12) oral, IM, or IV (SLOW IV push, over 30-45 minutes), every 2-4 hours, or Atarax (generic: hydroxyzine) 25 mg (12.5 for children under 12) every 2-4 hours.

SOLU-MEDROL (generic: methylprednisolone) 120 mg (40 mg for children under 12) IV/IM (Taper slowly once patient is stable.)

LOW DOSE BENZODIAZEPINE Alprazolam (quicker onset of action) or Lorazepam, .25 (1/4) mg every 4 hours (These doses are for mast cell stabilization purposes; higher doses would be necessary to address any anxiety symptoms.)

FAMOTIDINE: 40-60 mg every 4 hours

MONTELUKAST 10 mg (5 mg for children under 12) or Zafirlukast

OXYGEN by mask or cannula 100%

Albuterol nebulization if wheezing/shortness of breath

Avoid the use of contrast agents and also administer the above, excepting epinephrine, 1 hour before any radiology or surgical procedure. These "pre"medications are recommended before dental and other treatments, as well. In the case of scheduled radiology or other procedures, many patients also do best with the administration of an appropriate steroid, leukotriene inhibitor, and increased doses of H1 and H2 antagonists 12 hours before.

Compounding and/or special tubing/IV options may be necessary.

Consult patient's individual triggers in addition to the following list for any other necessary drugs:

General AVOID:

Beta-andregenic blockers
Alcohol
Amphoteracin B
Anticholinergic drugs
Dextran
Dextromethoraphan
Ethanol
Polymyxin B
Quinine
Vancomycin
Alpha-adrenergic blockers
Contrast agents and dyes

Pain AVOID:
Opioid narcotics
Coedine derivatives
Toradol
NSAIDS

Recommended instead:
Tylenol
Fentanyl, possibly requiring adjunct treatment with Zofran
Tramadol

Muscle Relaxants AVOID:
Atracurium
Doxacurium
D-tubocurarine
Metocurine
Mivacurium
Succinylcholine

Recommended instead:
Pancuronium
Vercuronium

Local anesthetics AVOID:
Benzocaine
Chloroprocaine
Procaine
Tetracine

Recommended instead (Note: many do not tolerate epinephrine, sulfites, or preservatives in local anesthetics)
Bupivacaine
Mepivicaine
Prilocaine
Levobupivacaine
Ropivacaine

RECOMMENDED IO Induction Meds:
Ketamine
Midazolam
Propofol

RECOMMENDED inhaled anesthetics:
Sevoflurane

*Drugs on this list were originally compiled by medical specialists on behalf of The Mastocytosis Society and distributed in their educational materials.