Hypersensitivity may be involved in severe COVID‐19

Abstract

Background Deaths attributed to Coronavirus Disease 2019 (COVID‐19) are mainly due to severe hypoxemic respiratory failure. Although the inflammatory storm has been considered the main pathogenesis of severe COVID‐19, hypersensitivity may be another important mechanism involved in severe cases, which have a perfect response to corticosteroids (CS). Method We detected the serum level of anti‐SARS‐CoV‐2–spike S1 protein‐specific IgE (SP‐IgE) and anti‐SARS‐CoV‐2 nucleocapsid protein‐specific IgE (NP‐IgE) in COVID‐19. Correlation of levels of specific IgE and clinical severity were analysed. Pulmonary function test and bronchial provocation test were conducted in early convalescence of COVID‐19. We also obtained histological samples via endoscopy to detect the evidence of mast cell activation. Result The levels of serum SP‐IgE and NP‐IgE were significantly higher in severe cases, and were correlated with the total lung severity scores (TLSS) and the PaO 2 /FiO 2 ratio. Nucleocapsid protein could be detected in both airway and intestinal tissues, which was stained positive together with activated mast cells, binded with IgE. Airway hyperresponsiveness (AHR) exists in the early convalescence of COVID‐19. After the application of CS in severe COVID‐19, SP‐IgE and NP‐IgE decreased, but maintained at a high level. Conclusion Hypersensitivity may be involved in severe COVID‐19.

Do basophil activation tests help elucidate allergic reactions to the ingredients in COVID‐19 vaccines?

“…It is known that the SARS‐CoV‐2 infection induces complement activation, which could activate basophils. Furthermore, anti‐SARS‐CoV‐2‐specific IgE and mast cells with positive staining for IgE and CD63 were observed in patients with severe SARS‐CoV‐2 infections 34 . Experiments with the BAT showing a decrease in BNT‐vaccine‐induced basophil activation by preincubation with wortmannin might pose an argument for an IgE‐mediated immune response to SARS‐CoV‐2 spike proteins in patients with a previous SARS‐CoV‐2 infection 28 .…”

“…Furthermore, anti‐SARS‐CoV‐2‐specific IgE and mast cells with positive staining for IgE and CD63 were observed in patients with severe SARS‐CoV‐2 infections. 34 Experiments with the BAT showing a decrease in BNT‐vaccine‐induced basophil activation by preincubation with wortmannin might pose an argument for an IgE‐mediated immune response to SARS‐CoV‐2 spike proteins in patients with a previous SARS‐CoV‐2 infection. 28 BATs with spike peptides showed a slightly higher activation compared to baseline (below the cut‐off) in some patients with previous SARS‐CoV‐2 infection, which could be a hint for such a mechanism.…”

Uncovering the Mast Cell Response to Mycobacterium tuberculosis

“…DAD is also observed in lungs of patients ADRS, acute hypersensitivity pneumonitis, idiopathic acute interstitial pneumonia, drug abuse, toxic inhalants, ingestants, connective tissue disease, viral and bacterial infections including some acute forms of tuberculosis ( 52 , 53 ). In addition, the levels of serum anti-SARS-CoV-2–spike S1 protein-specific IgE (SP-IgE) and anti-SARS-CoV-2 nucleocapsid protein-specific IgE (NP-IgE) appear to be significantly higher in patients suffering severe COVID-19; and SP-IgE levels correlated with the total lung severity scores and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) ( 54 ). Post-acute sequalae COVID-19 patients report significantly higher expression in serum of IL-6 and CXCL1; whereas no difference was observed on serum levels of IL-8, TNF, CCL2, CCL3, IL-17A, IL-33, and VEGF ( 55 ).…”

incidence of myocarditis and pericarditis in post COVID-19 unvaccinated patients

“…23 Other studies demonstrated that severe COVID-19 disease is associated with robust inflammatory responses including type two and hyper four hypersensitivity responses, resulting from overactivation of T cells and a subsequent cytokine storm. 24,25 manifestations of COVID-19 include mimicry of autoimmune diseases like Kawasaki disease, Guillain-Barre syndrome, vasculitis, myositis, and myocardial damage. 26 Puntmann et al found a 78% cardiac involvement assessed by Cardiac Magnetic Resonance Imaging (MRI) among patients with a confirmed diagnosis of COVID-19 eight weeks before enrollment 27 , most of whom were asymptomatic or had just mild symptoms.…”