Systemic Mastocytosis with Pruritus and Flushing: What to Do in Indolent or Smoldering Disease

This protocol applies to patients with indolent or smoldering systemic mastocytosis who experience pruritus and/or flushing of the skin — histamine-driven cutaneous symptoms that are a hallmark presentation in this setting.

In indolent systemic mastocytosis, treatment is primarily directed toward symptom control, anaphylaxis prevention, and managing associated complications. Controlling cutaneous symptoms such as pruritus is a central objective of first-line therapy.

First-line management targets histamine-mediated symptoms through H1-antihistamine therapy. The full protocol specifies which agents within this class are recommended and under what conditions dose adjustment may be considered.

Complete agent selection, dosing guidance, and escalation criteria are available in the full structured protocol below.