Alevizos, Michail, Karagkouni, Anna, Panagiotidou, Smaro et al. · Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2014 · DOI
When we experience stress, our body releases chemicals that can activate immune cells in the heart called mast cells. These activated mast cells release inflammatory substances that can trigger heart problems or make existing heart disease worse. This review found that stress-related activation of heart mast cells may be a key pathway connecting emotional stress to heart attacks and coronary artery disease.
ME/CFS patients frequently experience cardiac symptoms and autonomic dysfunction, and this study explicitly identifies ME/CFS as prone to coronary hypersensitivity reactions mediated by mast cell activation. Understanding how stress triggers mast cell-mediated cardiac inflammation may explain post-exertional malaise, orthostatic intolerance, and cardiac symptoms in ME/CFS, potentially opening new treatment avenues targeting mast cell inhibition.
This review does not provide direct clinical evidence that mast cell activation actually causes heart disease in ME/CFS patients, nor does it quantify the relative contribution of this mechanism compared to other factors. The inclusion of ME/CFS is mentioned theoretically rather than studied empirically, so no causal link specific to ME/CFS is established. The evidence is correlational and mechanistic, not causally proven.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Alevizos, Michail, Karagkouni, Anna, Panagiotidou, Smaro, Vasiadi, Magdalini, & Theoharides, Theoharis C (2014). Stress triggers coronary mast cells leading to cardiac events.. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. https://doi.org/10.1016/j.anai.2013.09.017
BibTeX
@article{mecfsatlas-alevizos-2014-stress-triggers,
author = {Alevizos, Michail and Karagkouni, Anna and Panagiotidou, Smaro and Vasiadi, Magdalini and Theoharides, Theoharis C},
title = {Stress triggers coronary mast cells leading to cardiac events.},
journal = {Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology},
year = {2014},
doi = {10.1016/j.anai.2013.09.017},
note = {PubMed: 24428962},
url = {https://www.mecfsatlas.com/evidence/alevizos-2014-stress-triggers},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/alevizos-2014-stress-triggers
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