Mast cell activation symptoms are prevalent in Long-COVID

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. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Automated summary

This study found that MCA symptoms were increased in LC patients after COVID-19 and mimicked the symptoms and severity reported by MCAS patients. This suggests that increased activation of aberrant mast cells induced by SARS-CoV-2 infection may underlie part of the pathophysiology of LC.