Although an important role for mast cells in several viral infections has been demonstrated, its role in the invasion of highly pathogenic H5N1 influenza virus is unknown. In the present study, we demonstrated that mast cells were activated significantly by H5N1 virus (A/chicken/Henan/1/2004) infection both in vivo and in vitro. Mast cells could possibly intensify the lung injury that results from H5N1 infection by releasing proinflammatory mediators, including histamine, tryptase and IFN-γ. Lung lesions and apoptosis induced by H5N1 infection were reduced dramatically by treatment with ketotifen, which is a mast cell degranulation inhibitor. Combination of ketotifen and neuraminidase inhibitor oseltamivir protected 100% of the mice from death post-infection. In conclusion, our data suggest that mast cells play a crucial role in the early stages of H5N1 influenza virus infection, and provide a new approach to combat highly pathogenic influenza virus infection.