Ehlers-Danlos syndrome is not classified as an immunodeficiency, and having EDS does not make you immunocompromised in the traditional medical sense. Your immune cells and antibodies function normally. However, EDS creates several indirect vulnerabilities that can make you more prone to infections and immune-related problems, which is likely why you’re asking the question in the first place.
Why EDS Isn’t an Immune Disorder
EDS is a connective tissue disorder, not an immune system disorder. It affects collagen, the structural protein that holds your body together, rather than the white blood cells, antibodies, or other components that fight infections. A review in the Journal of Translational Autoimmunity found that there is a “paucity of evidence for an immunological mechanism for EDS” and that no clearly defined role of the immune system has been established in any EDS subtype.
Case reports have suggested possible links between hypermobile EDS (hEDS) and immunodeficiency, but the same review noted these associations may be coincidental rather than causal. This distinction matters because being immunocompromised typically means your body cannot mount a normal defense against infections, and that’s not what happens in EDS.
How EDS Still Increases Infection Risk
Even though your immune system technically works, EDS can make infections more likely through a different route: your body’s physical barriers. Collagen is a key component of skin and the mucous membranes lining your urinary tract, gut, and respiratory system. When those barriers are structurally weaker, pathogens have an easier time getting in. Research has found a higher incidence of recurrent infections, particularly urinary tract infections, in hEDS patients compared to the general population.
There’s also evidence that the cells responsible for tissue repair behave differently in people with hEDS. A functional analysis of fibroblasts (the cells that build and maintain connective tissue) from hEDS patients showed altered immune responses, including decreased production of signaling molecules called cytokines. This means the local immune response at the site of an injury or infection may be slower or weaker than expected, even though the broader immune system is intact.
Surgical Infections Are Significantly Higher
One area where this vulnerability shows up clearly is surgery. EDS patients face dramatically higher rates of wound complications and post-surgical infections. In one large study of cervical spine surgery, 6.4% of EDS patients developed a surgical site infection within 90 days, compared to just 0.8% in the general surgical population. That’s roughly an eightfold increase in risk. Wound complications were about three times more common. A separate review of orthopedic procedures in EDS patients found average infection rates of 8.6%, with wound complications and surgical site infections occurring in 11% and 6% of cases respectively.
These elevated rates reflect the fragile tissue and impaired wound healing characteristic of EDS rather than a problem with the immune system itself. If you have EDS and need surgery, this is worth discussing with your surgical team so they can plan accordingly.
Mast Cell Activation: Overactive, Not Underactive
Many people with EDS experience immune-related symptoms that feel like something is wrong with their immune system, but the issue is often the opposite of immunodeficiency. Roughly 24% of EDS patients in one case series had a diagnosis of mast cell activation syndrome (MCAS), and in a larger dataset of over 37,000 patients, nearly 1 in 3 people with MCAS also had hEDS.
Mast cells are immune cells embedded in connective tissue throughout your body. They’re supposed to release chemical signals like histamine in a controlled way when they detect injury or infection. In people with hEDS, the disrupted collagen where these cells live appears to cause them to fire inappropriately, releasing their contents when there’s no real threat. This leads to symptoms like flushing, hives, gut problems, and allergic-type reactions. It’s immune overactivity, not underactivity. Your body is overreacting to harmless triggers rather than failing to respond to dangerous ones.
Autoimmune Conditions Are More Common
People with hEDS also develop autoimmune and inflammatory diseases at higher rates than the general population. In a study of hEDS patients, the most common associated conditions were fibromyalgia and psoriasis (22 cases each), followed by ankylosing spondylitis and psoriatic arthritis (11 cases each), and rheumatoid arthritis (9 cases). Lupus, Crohn’s disease, autoimmune thyroiditis, and inflammatory eye disease were also significantly more prevalent than in the general U.S. population.
This matters for the immunocompromised question because the treatments for these conditions often do suppress the immune system. Steroids, biologics, and other drugs used for rheumatoid arthritis or lupus can genuinely make you immunocompromised as a side effect of treatment. So while EDS itself doesn’t suppress your immune system, a comorbid autoimmune condition and its medications might. If you’re taking immunosuppressive drugs for an autoimmune condition alongside your EDS, that’s when the “immunocompromised” label would apply.
What This Means for COVID and Other Illnesses
The Ehlers-Danlos Society has addressed this directly: the risk of complications from illnesses like COVID-19 depends on your specific health concerns, not on the EDS diagnosis alone. The CDC does not list EDS as a condition that increases risk for severe viral outcomes. However, if you have coexisting heart problems, high blood pressure, lung conditions, or take immunosuppressive medications for an autoimmune disease, those individual factors do place you in a higher-risk category.
The practical takeaway is that EDS creates a complicated immune picture. Your core immune defenses work, but your body’s structural barriers are weaker, your mast cells may overreact, and you’re more likely than average to develop autoimmune conditions that could eventually require immune-suppressing treatment. None of that fits neatly into the “immunocompromised” box, but it does mean your relationship with infections and immune function is different from someone without EDS.