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We describe clinical symptoms, chemokine, cytokine, metabolomic and lipidomic derangements in a systemic mastocytosis patient following mRNA-1273 booster vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-eight chemokines and cytokines, 41 amino acids and 16 lipid classes were quantified with state-of-the-art methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mast cell activation (MCA) symptoms started 24\u00a0h 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\u00a0h 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\u00a0h similar to the vaccine booster MCA attack.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      A mRNA-1273 first booster vaccination likely caused a delayed severe MCA attack with highly elevated Th\n                      <jats:sub>2<\/jats:sub>\n                      -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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00011-025-02032-5","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T05:47:19Z","timestamp":1745905639000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["COVID-19 mRNA-1273 vaccination induced mast cell activation with strongly elevated Th2 cytokines in a systemic mastocytosis patient"],"prefix":"10.1007","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-9091","authenticated-orcid":false,"given":"Matthias","family":"Weiss-Tessbach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0497-4369","authenticated-orcid":false,"given":"Teresa","family":"Haider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1098-3357","authenticated-orcid":false,"given":"Aoife","family":"Gowran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9181-8614","authenticated-orcid":false,"given":"Lorenz","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8592-8259","authenticated-orcid":false,"given":"Jakob","family":"M\u00fchlbacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6243-9196","authenticated-orcid":false,"given":"Jelena","family":"Brankovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1301-8694","authenticated-orcid":false,"given":"Markus","family":"Wahrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5652-7977","authenticated-orcid":false,"given":"Bernd","family":"Jilma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8294-0797","authenticated-orcid":false,"given":"Thomas","family":"Boehm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"2032_CR1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1001\/jama.2021.1967","volume":"325","author":"TT Shimabukuro","year":"2021","unstructured":"Shimabukuro TT, Cole M, Su JR. 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