COVID-19 mRNA-1273 vaccination induced mast cell activation with strongly elevated Th2 cytokines in a systemic mastocytosis patient

• Published in: Inflammation research Vol. 74; no. 1; p. 71
• Main Authors: Weiss-Tessbach, Matthias, Haider, Teresa, Gowran, Aoife, Schubert, Lorenz, Mühlbacher, Jakob, Brankovic, Jelena, Wahrmann, Markus, Jilma, Bernd, Boehm, Thomas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2025; Springer Nature B.V
• Subjects: Allergology; Amino acids; Biomedical and Life Sciences; Biomedicine; Cell activation; Chemokines; COVID-19; CXCL10 protein; Cytokines; Dermatology; Granulocyte-macrophage colony-stimulating factor; Immunization; Immunology; Interleukin 1 receptor antagonist; Interleukin 1 receptors; Interleukin 6; Interleukin 6 receptors; Lipids; Lymphocytes T; Mastocytosis; Metabolism; Metabolomics; mRNA; Neurology; Original Research Paper; Pharmacology/Toxicology; Receptors; Rheumatology; Severe acute respiratory syndrome coronavirus 2; Tryptase; Vaccines; Viral diseases; Histamine; SARS-Cov-2; Th; Tocilizumab; biased cytokines; mRNA-1273 vaccination; Systemic mastocytosis
• ISSN: 1023-3830; 1420-908X; 1420-908X
• DOI: 10.1007/s00011-025-02032-5

Objective and design SARS-CoV-2 vaccines are recommended for mastocytosis patients. We describe clinical symptoms, chemokine, cytokine, metabolomic and lipidomic derangements in a systemic mastocytosis patient following mRNA-1273 booster vaccination. Methods Twenty-eight chemokines and cytokines, 41 amino acids and 16 lipid classes were quantified with state-of-the-art methods. Results Mast cell activation (MCA) symptoms started 24 h after the mRNA-1273 booster vaccination with significant metabolic, lipidomic and cytokine derangements. Histamine concentrations peaked at life-threatening 18 ng/ml concomitant with high tryptase. Peak plasma IL-1Ra, IL-5, IL-6, IL-10, IL-11, CXCL10 and GM-CSF concentrations were elevated 54-, 4.9-, 85-, 54-, 6.1-, 19- and 6.4-fold respectively. Tocilizumab, an IL-6 receptor antagonist, was administered 6 h after admission, because of the highly elevated IL-6 concentrations. More than one year later IL-6 was highly elevated during another MCA attack likely caused by a PCR-proven SARS-CoV-2 infection and tocilizumab was again used. Clinical symptoms improved during the following 12 h similar to the vaccine booster MCA attack. Conclusions A mRNA-1273 first booster vaccination likely caused a delayed severe MCA attack with highly elevated Th 2 -biased cytokines with metabolic and lipidomic derangements. Administration of an IL-6 receptor blocker during both MCA attacks might have shortened the duration of clinical symptoms.