Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome: Mastocytosis and post-mortem diagnosis

Kounis, Nicholas G.; Koniari, Ioanna; Soufras, George D.; Patsouras, Nicholas; Hahalis, George

doi:10.1016/j.ijcard.2017.02.144

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…The infarction was presumably due to allergic acute coronary syndrome [5]. Avoidance of crustaceans (prawn, langoustines, crab), kiwi, pineapple, fig, and foods containing traces of the above was recommended.…”

Section: Methodsmentioning

confidence: 99%

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Mastocytosis and the Fig Wasp (Blastophaga psenes)

Armentia

Pineda

Fernandez-Cortés

et al. 2019

Int Arch Allergy Immunol

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Background: Mastocytosis involves the abnormal proliferation of mast cells and clinical variability. In the case of anaphylaxis, the triggering antigen, often associated with Hymenoptera allergens, must be identified. The common fig (Ficus carica) requires the fig wasp (Blastophaga psenes) for pollination. Objective: We evaluated the ingestion of B. psenes as a trigger of anaphylaxis in patients with mastocytosis. Material and Methods: Skin prick tests (SPTs) and specific immunoglobulin E to the possible involved allergens were carried out in the patient and in 4 controls allergic to Hymenoptera and fig. Given the possibility of hidden allergens, we studied the source (figs of various origins) and possible hypersensitivity to Hymenoptera allergens, including the fig wasp (B. psenes). Results: In all subjects, the SPT resulted in a wheal (larger than with histamine) with the extract of the inferior part of the female fig but not with the male extract (lower pole and stem). Immune detection was made with the stem and inferior part of figs and venom of Polistes and Vespula. Recognition bands were observed at 25 kDa with female fig extracts that were also recognized by the patient with anaphylaxis to Hymenoptera venom. Conclusions: We cannot exclude the possibility that the ingestion of fig with Blastophaga antigens may have triggered anaphylaxis in our patient.

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Section: Methodsmentioning

confidence: 99%

“…In indolent forms, many patients are almost symptomless, but in other forms, symptoms can be repeated and severe. In the case of anaphylaxis, the triggering antigen, often associated with Hymenoptera allergens, must be identified [1-5]. …”

Section: Introductionmentioning

confidence: 99%

Mastocytosis and the Fig Wasp (Blastophaga psenes)

Armentia

Pineda

Fernandez-Cortés

et al. 2019

Int Arch Allergy Immunol

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show abstract

“…Kounis syndrome, if present, would have been demonstrated at autopsy with coronary artery thrombosis along with mast cell or eosinophilic infiltration of the vessel intima. 2 The Kounis syndrome occurs with Hymenoptera envenomation and could have been present in our individual-although there were simply not enough data provided to make such a diagnosis. It seems to us that Kounis syndrome, if present, may have contributed to some of the deaths that involved fewer than 300 stings from the group of 11 lethal honeybee attacks in Arizona tabulated in our paper.…”

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confidence: 90%

The Reply

Rahimian

Shirazi

Schmidt

et al. 2020

The American Journal of Medicine

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“…Anaphylaxis and acute coronary syndromes (ACS) are discrete clinical presentations that usually present independently and are commonly treated in the emergency departments (EDs). [ 1] Kounis syndrome (KS) is a rare condition characterized by the coexistence of allergic reactions and ACS. KS was firstly described in detail by Kounis and Zavras in 1991 as an allergic angina syndrome.…”

Section: Dear Editormentioning

confidence: 99%