Interview with Dr. Janice Joneja

Dr. Janice Joneja is a researcher, educator, author, and clinical counselor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. She holds a Ph.D. in medical microbiology and immunology and has been a member of the academic faculty of the University of British Columbia and other universities.

The content provided is for informational purposes only and is not intended to medically diagnose or prescribe a solution for your condition.

Key Points

We’re in the early stages of understanding the relationship between mast cells and with this new novel coronavirus / covid19 because there has been so little research.

Mast cells are a very small part of the way our immune system functions in the case of fighting an infection

Viruses themselves can degranulate mast cells. Therefore, if an MCAS patient gets the virus, you might see more of the symptoms that we typically see when a mast cell gets triggered and degranulate.

This virus, as far as we know now will make no difference to the people with mast cell activation disorders except that it may create a situation where there are more mediators being produced and the patient must take appropriate measures for that.

The Full Transcript

1:48: [Samia] What we wanted to talk to you about today was mast cell activation syndrome and the coronavirus / covid19. I know there is not a lot of information out there and people are reading things and getting nervous. We wanted to get a science perspective. Understanding that there is very little information out there, we would love to get your perspective. I think I sent you a couple of things that people are worried about. One is that taking antihistamines will weaken the immune system and cause us to be more susceptible to getting the coronavirus / covid19 and on the other hand, some people are assuming that because our immune system is already on alert that we won’t get sick.

2:41 [Dr. Joneja] What I want to do is to focus on the science that we know. The only thing we can base our assumptions and practice on is real science. Not anecdotes. Not these types of piecemeal information that we’re getting on the internet. I am a scientist. I will deal with science and the way that we can apply science in practice. That has always been my focus. The problem that we have in science is that with mast cells and with this new novel coronavirus / covid19, we’re in the early stages of understanding it because there has been so little research in that field.

How mast cells function

3:50: Let’s look at mast cells to begin with. We’ve known for a long time the function of mast cells in allergy and also in the field of parasites and then we understood as we came into the era of mastocytosis in inflammation that the mast cell mediators that are made by the mast cell and are stored within the mast cell and released have a high range of functions that we understood from allergy, anaphylactic symptoms because symptoms are the result of the mediators being released. So we’ve got a variety of triggers for mast cells to release their mediators. The symptoms that anyone is experiencing whether it’s allergy, mastocytosis, fighting a parasite or it’s now in the mast cell activation disorders – all of the symptoms are a result of the release of the mediators that are stored within the mast cells. Each of those mediators has its own range of symptoms – histamines have their own range of symptoms, leukotrienes have their range of symptoms, and all of the different ones (mediators) there are dozens of them but each has their own that we experience once those mast cells are activated. Now that’s the important thing about mast cell disorders – what causes the mast cells to release those mediators that are causing the symptoms. That’s when we come to allergy, we know that the allergen will produce antibodies called IgE and they will then sit on the surface of mast cells and release the mediators. We know there are various other triggers that we’re only recognizing within the last decade or so that mast cells can release these mediators when you’ve got too many mast cells or your mast cells tend to be more sensitive to the triggers.

6:29: Now what are these triggers? This is the important thing for people with mast cell disorders. What are my triggers? If I can avoid my triggers, then I might be able to avoid the miserable symptoms that I get. And everyone is different and your listeners will have a good knowledge of the triggers they might be exposed to.

How a virus functions and our body’s immune response

7:00: Mast cells now, we realize, release these mediators, some of which may help us to fight disease. The thing is we’ve got to take into account one, the triggers, and two, how are these mediators helping – either to fight that disease or in some cases, make it worse.  In the case of the coronavirus / covid19, we know that a virus can trigger the release of mediators from the mast cells. So the hope is, that perhaps if these viruses could trigger the release of these mediators, perhaps the mediators would help us to fight the disease. However, that is way beyond anything that we understand from research because mast cells in fighting infections, is a very small part of the way our immune system functions in the case of an infection. When we’re infected by a virus, for example, we’ll use coronavirus / covid19 as we understand it, and we don’t have a great understanding yet. But the way that this can happen is the virus gets into the body and the way it gets into the body is by honing in on what we call a receptor in order to do anything with the body something whether its an infective organism has to actually get into the cell. And the virus gets into the cell by latching on to a receptor on that cell. You’ve probably seen pictures of the coronavirus / covid19, it’s got spikes all over it. Now those spikes are made up of a particular protein and that protein, in the case of the coronavirus / covid19, its very specific to the receptor that it’s going to latch onto in the body – its called an ACE protein and by latching onto that, the virus can make its way onto the cell, in the cell, it takes over the function. Then the cell itself has got nothing to do with what happens next, it’s the viral RNA, not DNA, RNA in the case of the coronavirus / covid19 which then programs that cell to make virus particles. The cells have got to stop doing their own thing, it is now controlled by that virus RNA. It’s like having a factory that’s making car parts, and now somebody comes in and says stop everything, now you’ve got to make respiratory ventilators. That’s exactly what happens with a virus, it gets into the cell, stops the cell function and tells it to make viruses. And then it releases it into the body and that’s our infection. So, what we’re looking at now is the cells that are going to make those virus particles and then the immune system realizes there is a foreign invader here that’s taking over some function so we really gear up and destroy this invader. In the case of the coronavirus / covid19, it starts with what we call T-cell lymphocytes, there are two different types, then we’ve got the antibody-producing lymphocytes, the cells that will produce antibodies and we’ve got antibodies themselves with is IgM and IgG, you may have heard of those – quite different from IgE that we talk about with allergies. The body’s immune system has started to gear up to produce in response to the virus – the T-cells get activated, they activate the rest of the immune system and the immune system then produces antibodies to block the virus but before they are produced, we’ve got cytokines and it’s the cytokines that are going to fight this virus but it’s also the cytokines and the mediators that cause the symptoms of the infection. It’s not actually the virus that causes the symptoms, it’s the immune response that causes the symptoms.

The role of mast cells in our body’s immune response

12:18: What we have to look at is put these two things together. I’ve spoken about the mast cells and they can get triggered to release mediators. On the other hand, we’ve got the immune system using T-cells and B-cells and antibodies to fight the virus – different. Now we don’t know, our research doesn’t show us the degree to which a mast cell can contribute to an immunologically fighting the virus. In fact, our knowledge is minuscule when it comes to viruses and mast cells. And we know nothing about how Coronavirus / covid19es and mast cells will be associated but keep in mind that the mast cell, based on the knowledge that we have now, plays a very little part in fighting that virus. It’s the rest of the immune system, geared up with T-cells and antibody-producing cells and it takes the body a few days to get all that in place so that’s why there is a lag phase between infection by the virus and the expression of symptoms. [Samia] Up to 14 days, right? [Dr. Joneja] No, it can be 3 to 4 days but it isn’t the day that you get the virus. It could be 3 to 4 days to 6 days. It depends. It’s within that 14-day period. Some people will be starting to produce antibodies much earlier perhaps – 2,3,4 days and probably we’ve got antibodies that we can detect within that period. So not 14 days but much earlier.

14:13: We have to remember that viruses themselves can degranulate mast cells. Antibodies can degranulate mast cells. So what we could see would be an increase in the mast cell and associated symptoms as a result of the virus or the antibodies releasing those mediators. But in and of themselves, they’re not that important as far as we know in fighting the virus. [Samia] if we did get the virus, you might see more of the symptoms that we typically see when a mast cell gets triggered and degranulate. The type of symptoms that an MCAS patient sees, you might see more of those symptoms because they are getting triggered.

15:08: [Dr. Joneja] And the important thing to remember is just to treat it as if you’ve got any other trigger for your mast cell disorder. Antihistamines – fine because you don’t want an overwhelming amount of histamine, any other histamine, even mast cell stabilizers, as far as we know will be fine because you don’t want to be overwhelmed by the mediators being released from the mast cells. Because, as far as we know, they’re not really doing anything very much to fight the virus. In fact, mast cells are being triggered to produce that by the virus or the antibodies maybe.

Coronavirus and Mast Cell Activation Syndrome

15:53 It’s something to keep in mind – don’t get worried. You’re not suppressing your immune system or your immune system’s ability to fight the virus by taking antihistamines. Take the antihistamines. Take any mast cell stabilizers – Ketotifen or whatever you may have been prescribed by your doctor- because you do not want to have these symptoms made worse at the time that you might be fighting the virus too.

16:25: [Samia] And what about people who have multiple comorbidities. I guess it depends on what the comorbidity is but I guess the hypothesis that people are taking is that if you have multiple comorbidities that you might also be at increased risk. [Dr. Joneja] Oh you are – I mean increased risk at the symptoms of the virus. That’s what you’re more at risk for.

16:55: [Samia] That’s really helpful. I think the message to take from this is don’t panic. Continue your protocol. If you’re taking antihistamines and you’re taking mast cell stabilizers continue taking that and just take the same precautions that everyone else is taking. [Dr. Joneja] Exactly. Not at increased risk and you’re not doing any harm by taking your usual medications. Always check with your doctor of course because everybody is different and they will have been in contact with their doctor in order to make sure that all of their problems are addressed appropriately. But this virus, as far as we know now will make no difference to the people with mast cell activation disorders except that it may create a situation where there are more mediators being produced and take appropriate measures for that. [Samia] Right because you might have increased symptoms [Dr. Joneja] You may have more histamines being release so take your antihistamines and that sort of thing. You’re not harming your body’s ability to fight the virus, no. [Samia] and also if you have mast cell activation syndrome, you should think that your body is protecting you more from this virus because it’s a very small part of the immune response. Behave and act the same way everyone else is and if that’s self-isolation or social distancing or quarantine if you’ve been exposed do that but there’s really no difference for a patient that has MCAS.

[Dr. Joneja] That’s exactly true. They shouldn’t feel they are more at risk or less liable to get the infection. Now at the moment, for the knowledge that we have, there is no difference in either risk or benefit.               

18:58: [Samia] Do you have any other recommendation in terms of – I think I’ve listened to several podcasts with researchers and doctors and the take-away is – take care of yourself, eat right, sleep well, get some exercise to the extent that you can and that’s the way you protect your body. There is no magical formula and supplements like elderberry that is somehow going to protect you. [Dr. Jonega] No, unfortunately, a lot of people have tried to benefit from this by promoting different varieties of supplements or strange ways – I even saw this, I was absolutely appalled that someone was trying to get people to pay to send them money because they would mediate some passage in the Bible that was going to protect them from the disease. I was appalled that people would take advantage of people who are vulnerable. But no, at the present level of our knowledge, because coronavirus / covid19 is so new, at least this one is.

History of the various coronavirus / covid19

20:19: We’ve had four Coronavirus / covid19 as you’re probably very well aware this at a human coronavirus / covid19 is the cause of the common cold. In 2020 we had SARS that was the original SARS virus, that’s when we started to understand that there is another coronavirus / covid19 out there that is suddenly moving from animal to human and the humans have no resilience because they don’t have any exposure to them. Then we had MERS which came in about 10 years later, in 2012. Same thing, it’s a respiratory virus and actually this is called SARS2, it’s very similar to the classic SARS. This is the third acute respiratory virus that we have been exposed to as humans and so we’re learning as we go as to what exactly this virus does why it’s so aggressive and there is no little research before 2002 because coronavirus / covid19es weren’t being researched very much, they were mild, cold, quasi-diseases sort of thing and so we don’t know an awful lot, we’re learning a lot quickly.

Message to patients with mast cell activation syndrome

22:06: [Samia] The message really is to stay calm and adhere to the same protocol that everyone else is adhering to and if you have medication, take the medication and try to live as healthy a lifestyle as possible. Avoid the regular triggers that you normally have. [Dr. Joneja] Exactly so, there really is nothing different because when we talk about comorbidities we have much more severe ones for people who have cardiac problems, diabetes, cancer – those are the ones that we have to be really aware of because they are fighting quite a different enemy if you like. But with any mast cell disorder, treat appropriately to the mast cell symptoms which may be exacerbated either the virus or the antibodies produced by the immune system to fight the virus. But you’re not doing any harm by taking the medications in controlling the symptoms.

More information on Dr. Janice Joneja

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