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Although the inflammatory storm has been considered the main pathogenesis of severe COVID\u201019, hypersensitivity may be another important mechanism involved in severe cases, which have a perfect response to corticosteroids (CS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We detected the serum level of anti\u2010SARS\u2010CoV\u20102\u2013spike S1 protein\u2010specific IgE (SP\u2010IgE) and anti\u2010SARS\u2010CoV\u20102 nucleocapsid protein\u2010specific IgE (NP\u2010IgE) in COVID\u201019. 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\u201019. We also obtained histological samples via endoscopy to detect the evidence of mast cell activation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>The levels of serum SP\u2010IgE and NP\u2010IgE were significantly higher in severe cases, and were correlated with the total lung severity scores (TLSS) and the PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> 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\u201019. After the application of CS in severe COVID\u201019, SP\u2010IgE and NP\u2010IgE decreased, but maintained at a high level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypersensitivity may be involved in severe COVID\u201019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.14023","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T20:33:19Z","timestamp":1632774799000},"page":"324-333","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Hypersensitivity may be involved in severe COVID\u201019"],"prefix":"10.1111","volume":"52","author":[{"given":"Cuiyan","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"},{"name":"Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of 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