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. 2021 Nov:112:217-226.
doi: 10.1016/j.ijid.2021.09.043. Epub 2021 Sep 23.

Mast cell activation symptoms are prevalent in Long-COVID

Leonard B Weinstock  1 , Jill B Brook  2 , Arthur S Walters  3 , Ashleigh Goris  4 , Lawrence B Afrin  5 , Gerhard J Molderings  6
Affiliations

Mast cell activation symptoms are prevalent in Long-COVID

Leonard B Weinstock et al. Int J Infect Dis. 2021 Nov.

Abstract

Objectives: Hyper-inflammation caused by COVID-19 may be mediated by mast cell activation (MCA) which has also been hypothesized to cause Long-COVID (LC) symptoms. We determined prevalence/severity of MCA symptoms in LC.

Methods: Adults in LC-focused Facebook support groups were recruited for online assessment of symptoms before and after COVID-19. Questions included presence and severity of known MCA and LC symptoms and validated assessments of fatigue and quality of life. General population controls and mast cell activation syndrome (MCAS) patients were recruited for comparison if they were ≥18 years of age and never had overt COVID-19 symptoms.

Results: There were 136 LC subjects (89.7% females, age 46.9 ±12.9 years), 136 controls (65.4% females, age 49.2 ±15.5), and 80 MCAS patients (85.0% females, age 47.7 ±16.4). Pre-COVID-19 LC subjects and controls had virtually identical MCA symptom and severity analysis. Post-COVID-19 LC subjects and MCAS patients prior to treatment had virtually identical MCA symptom and severity analysis.

Conclusions: MCA symptoms were increased in LC and mimicked the symptoms and severity reported by patients who have MCAS. Increased activation of aberrant mast cells induced by SARS-CoV-2 infection by various mechanisms may underlie part of the pathophysiology of LC, possibly suggesting routes to effective therapy.

Keywords: COVID-19; Long-COVID; fatigue; mast cell activation.

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Figures

Figure 1
Figure 1
Mean mast cell mediator release syndrome scores for each group, with whiskers showing 95% confidence intervals.
Figure 2
Figure 2
Mean mast cell mediator release syndrome cumulative severity for each group, with whiskers showing 95% confidence intervals.
Figure 3
Figure 3
Spider web plots of mean mast cell mediator release syndrome scores.
Figure 4
Figure 4
Changes in Long-COVID participants mean symptom severity scores before and after COVID-19 (all are statistically different; p<0.05).
See this image and copyright information in PMC

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