Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation
Fabrizio Salvucci, Roberto Codella, Adriana Coppola, Irene Zacchei, Gabriella Grassi, Maria Luisa Anti, Nicolita Nitisoara, Livio Luzi, Carmine Gazzaruso
Frontiers in Cardiovascular Medicine, doi:10.3389/fcvm.2023.1202696
Introduction: Long-COVID is a broadly defined condition and there are no effective therapies. Cardiovascular manifestations of long-COVID include high heart rate, postural tachycardia, and palpitations. Previous studies have suggested that mast cell activation (MCA) may play a role in the pathophysiology of long-COVID, including in the mechanisms of its cardiovascular manifestations. The present study aimed to evaluate the effectiveness of a treatment with blockers of histamine receptors in patients with long-COVID who did not respond to other therapies. Methods: In all, 14 patients (F/M = 9/5; 49.5 ± 11.5 years) and 13 controls (F/M = 8/5; 47.3 ± 8.0 years) with long-COVID symptoms attributed to MCA were evaluated. Patients were treated with fexofenadine (180 mg/day) and famotidine (40 mg/day). Fatigue, brain fog, abdominal disorders, and increased heart rate were evaluated in treated and untreated patients at baseline and 20 days later. Results: Long-COVID symptoms disappeared completely in 29% of treated patients. There was a significant improvement in each of the considered symptoms (improved or disappeared) in all treated patients, and the improvement grade was significantly greater in treated patients compared to controls. No significant differences in the outcomes were observed in the controls. Conclusions: Our data confirm that histamine receptors blockade may be an effective target to successfully treat long-COVID. Our finding supports the underlying role of MCA in the pathophysiology of long-COVID.
Ethics statement Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.
Author contributions FS, LL, and CG designed the study. AC, RC, and CG analysed the data and drafted the manuscript. GG, IZ, MA, and NN contributed with data acquisition. FS, MA, NN, and LL assisted with the literature search and revised the manuscript. IZ, GG, and AC provided critical input and extensively revised the manuscript. All authors contributed to the article and approved the submitted version.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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'abstract': '<jats:sec><jats:title>Introduction</jats:title><jats:p>Long-COVID is a broadly defined '
'condition and there are no effective therapies. Cardiovascular manifestations of long-COVID '
'include high heart rate, postural tachycardia, and palpitations. Previous studies have '
'suggested that mast cell activation (MCA) may play a role in the pathophysiology of '
'long-COVID, including in the mechanisms of its cardiovascular manifestations. The present '
'study aimed to evaluate the effectiveness of a treatment with blockers of histamine receptors '
'in patients with long-COVID who did not respond to other '
'therapies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In all, 14 '
'patients (F/M\u2009=\u20099/5; 49.5\u2009±\u200911.5 years) and 13 controls (F/M\u2009=\u2009'
'8/5; 47.3\u2009±\u20098.0 years) with long-COVID symptoms attributed to MCA were evaluated. '
'Patients were treated with fexofenadine (180\u2005mg/day) and famotidine (40\u2005mg/day). '
'Fatigue, brain fog, abdominal disorders, and increased heart rate were evaluated in treated '
'and untreated patients at baseline and 20 days '
'later.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Long-COVID '
'symptoms disappeared completely in 29% of treated patients. There was a significant '
'improvement in each of the considered symptoms (improved or disappeared) in all treated '
'patients, and the improvement grade was significantly greater in treated patients compared to '
'controls. No significant differences in the outcomes were observed in the '
'controls.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our data '
'confirm that histamine receptors blockade may be an effective target to successfully treat '
'long-COVID. Our finding supports the underlying role of MCA in the pathophysiology of '
'long-COVID.</jats:p></jats:sec>',
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