Kounis syndrome: A more commonly encountered cause of acute coronary syndrome

Abstract

Kounis syndrome (KS) has been defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults. It was thought to be a rare condition but is now being more commonly identified as the cause of acute coronary events in patients without previous history of coronary artery disease (CAD). The most identified KS cases have been provoked by medications on elderly male patients.The purpose of this case report is to describe an unusual case of KS, triggered by a food allergen in a young female patient. This case reminds us that it is important to have a high index of suspicion, particularly in MI patients presenting without previous history of CAD. In this manner, an appropriate management, considering both cardiac and allergic components of KS, can be given without further delay and progression of symptoms.

Bee Attack or Heart Attack: Kounis Syndrome

“…KS, once a rare entity, is now increasingly recognized by clinicians as a potential cause for ACS [ 2 ]. Although KS has been encountered worldwide, it has been more frequently seen and reported in countries such as Greece, Italy, Spain, and Turkey.…”

“…Beta-blockers, while used in ACS, may lead to unopposed alpha-adrenergic activity and worsening vasospasm. Epinephrine, on the other hand, is widely used for anaphylactic reactions but must be cautiously used in KS as it may paradoxically worsen vasospasm [ 2 ].…”

“…There is inadequate data regarding the exact incidence and prevalence of KS. According to one cohort study, the incidence of KS in hospitalized patients with hypersensitivity or anaphylactic reactions was 1.1% [ 2 ]. After exposure to an allergen, there is activation of mast cells with concurrent interaction of T-lymphocytes and macrophages.…”

Kounis Syndrome: Allergic Vasospastic Cardiac Event

“…In the acute setting, beta-blocker use can cause unopposed alpha-adrenergic activity, further reducing coronary perfusion. Epinephrine is commonly used in an anaphylactic reaction; however, in KS patients close cardiac monitoring is needed as epinephrine can induce coronary vasoconstriction as well [8].…”

Optimal management of coronary artery disease in cancer patients

“…Cancer-related CAD should be distinguished from Kounis syndrome (KS), which is defined as a special type of ACS that occurs secondary to allergic reaction by inflammatory mediators mainly released from activated cells. 80,81 Anticancer agents have hapten characteristics. As previously reported, approximately 42% of patients display hypersensitivity reaction, 2% have severe allergy after paclitaxel treatment, and 19.27% of patients treated with capecitabine, oxaliplatin, or bevacizumab have allergic reactions.…”