Sorry I missed this question and my MCAS doc says that the standard dose of Ketotefin ranges from 2 mg to 8 mg per day. I don't think he has anyone taking more than 8 mg per day. I took 4 mg per day for about 1.5 yrs (maybe slightly longer)? When my MCAS was very bad, I took Atarax as a rescue med and without it, am certain I would have had to use the EpiPen. Now I have not taken Atarax in about 10 months, except as a pre-med for IVIG, and at this point, am fairly certain I do not even need it for IVIG but continue just to be extra cautious. Have you tried Atarax for your skin rash? Am wondering if it would help? Edit: My MCAS doc had me take Atarax b/c I do not do well with Benadryl.