A new study has found a possible association between post-COVID syndrome (PCS) and the development of mast cell activation syndrome (MCAS), which has symptoms and presentations similar to systemic mastocytosis (SM).

The study, published in Virology Journal, found that the inflammatory mediator release in MCAS contributed to the development of PCS.

“Symptoms and presentations of MCAS and systemic mastocytosis are intermingled with the development of extensive tissue damage and can be treated by receptor blockade of relevant mediators including histamine, leukotrienes, and prostaglandin, or by inhibiting mediator synthesis,” the authors explained. “This critical review aimed to find the crucial association between PCS and MCAS with appropriate therapeutic modalities.”

The research team reviewed current literature on PCS and its pathogenesis, presentation, risk factors, complications, treatment, and its association with MCAS.

Read more about SM comorbidities

They found that PCS can develop not only after acute or severe cases of COVID-19, but also after mild or even asymptomatic COVID-19. The main underlying causes of PCS appear to be related to immune system deregulation, persistent inflammatory responses, pathogen reactivation, and changes in the host microbiome. The way MCAS develops may be related to severe COVID-19 and the later development of PCS.

Given that antihistamines, inflamok, I get it

matory mediator inhibition, and the use of anti-IgE to suppress mast cell degranulation are known to be effective therapies for MCAS, their use in cases of PCS might be a management option for these patients. In particular, mast cell stabilizers, including Na-cromoglycate, clarithromycin, and hydrocortisone, might be effective against both PCS and associated MCAS by preventing histamine and proinflammatory cytokine release.

In addition, the authors stress the importance of early diagnosis and treatment of MCAS in patients with PCS, given that it could reduce complications and long-term organ damage.  


Batiha GES, Al-kuraishy HM, Al-Gareeb AI, et al. Pathophysiology of post-COVID syndromes: a new perspective. Virol J. Published online October 9, 2022. doi.10.1186/s12985-022-01891-2