Anaphylactic shock with methylprednisolone, Kounis syndrome and hypersensitivity to corticosteroids: a clinical paradox

Abstract

Corticosteroids are widely used for the treatment of allergic reactions but paradoxically themselves may induce acute, delayed, local or systemic allergic reactions and even anaphylaxis with Kounis syndrome. They can suppress the release of arachidonic acid from mast cell membranes, via phospholipase A2 and eicosanoid biosynthesis inhibition. Corticosteroids can promote cell apoptosis and mediate in annexin or lipocortin synthesis, substances that modulate inflammatory cell activation, adhesion molecule expression, transmigratory and phagocytic functions. Antigen-antibody reaction, hapten formation, and medication contaminants are some of the incriminated causes. Patients with atopic diathesis are particularly vulnerable. Complete and thorough previous history of drug reactions or allergies is necessary before administration of any particular medication including corticosteroids.

Drug-Induced Kounis Syndrome: Latest Novelties

“…Paradoxically, medications used to treat anaphylaxis have been reported to cause KS, such as corticosteroids [ 1 ••, 18 ], ranitidine [ 19 ], and adrenaline itself [ 20 , 21 •]. In addition, drugs present in stents that prevent re-endothelialisation (everolimus, zotarolimus, or biolimus) or materials that make up cardiac stents (nickel, chromium, or titanium) have been reported to cause KS as well [ 1 ••, 22 ].…”

Authors’ reply - anaphylactic shock with methylprednisolone, Kounis syndrome and Hypersitivity to corticosteroids: a clinical paradox

“…in their comment to our case report on a one-year-old male presenting anaphylactic shock episodes triggered by intravenous administration of methylprednisolone sodium succinatum, Kounis et al, highlighted a poor-known clinical entity determined by systemic use of corticosteroids (the so-called “Kounis syndrome type I”) [1]. Authors have furtherly raised the important issue of high risk of adverse drug reaction in patients with atopic diathesis.…”

Immune checkpoint inhibitor-induced myocarditis in lung cancer patients: a case report of sintilimab-induced myocarditis and a review of the literature

“…Corticosteroid therapy is a double-edged sword which may induce new allergic reactions while treating other immune reactions (43,44). Previous case reports have shown high levels of myocardial biomarkers such as N terminal pro-hormone B-type natriuretic peptide (NT-proBNP), high sensitivity (hs)-troponin, and creatine kinase (CK) (10,18,20).…”