Kounis syndrome caused by anaphylaxis without skin manifestations after cefazolin administration

Adachi, Hidenori; Ihara, Madoka; Nojima, Yuhei; Kurimoto, Tetsuya; Nanto, Sinsuke

doi:10.1016/j.jaip.2018.05.030

Cited by 26 publications

(17 citation statements)

References 8 publications

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“…Pathogenesis involves mast cell activation and degranulation, which can ultimately lead to coronary artery vasospasm and atheromatous plaque erosion, rupture, and thrombus formation [5,6]. It is diagnosed infrequently; however, it is common in individuals with an allergic background [5]. Despite having a significant allergic history, anaphylaxis is a less likely etiology for shock in this patient without exposure to known allergens and stable hemodynamics on presentation.…”

Section: Discussionmentioning

confidence: 82%

“…An important consideration on the differential was a separate entity of acute coronary syndrome, previously described in the literature, called Kounis syndrome. Also known as allergic angina or allergic acute coronary syndrome, Kounis syndrome is usually precipitated by an acute allergic reaction triggering the release of several inflammatory mediators [5]. Pathogenesis involves mast cell activation and degranulation, which can ultimately lead to coronary artery vasospasm and atheromatous plaque erosion, rupture, and thrombus formation [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…Also known as allergic angina or allergic acute coronary syndrome, Kounis syndrome is usually precipitated by an acute allergic reaction triggering the release of several inflammatory mediators [5]. Pathogenesis involves mast cell activation and degranulation, which can ultimately lead to coronary artery vasospasm and atheromatous plaque erosion, rupture, and thrombus formation [5,6]. It is diagnosed infrequently; however, it is common in individuals with an allergic background [5].…”

Section: Discussionmentioning

confidence: 99%

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Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

Radwan

Gill

Ghazzal

et al. 2020

Case Reports in Cardiology

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Alpha-gal (AG) allergy is an IgE-mediated allergic reaction to galactose-alpha-1,3-galactose found in mammalian meat. Heparin, being derived from porcine intestinal tissue, may have a degree of cross-reactivity with AG antigen and thus place patients at risk for allergic and even anaphylactic reactions. This is especially important in patients with myocardial infarction (MI) and mechanical circulatory support, such as a left ventricular assist device (LVAD), since anticoagulation is immediately required. Therefore, individualized assessment and preoperative planning is needed regarding the use of heparin vs. nonheparinoid products in such a population.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

Radwan

Gill

Ghazzal

et al. 2020

Case Reports in Cardiology

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“…Source of funding: No funding has been received stateMeNt oF ethICs increase in tryptase levels did not allowed us to determine that anaphylaxis was associated to the CAS. However, skin manifestations and tryptase are not always present in anaphylaxis [10,11,12] . Other types of pro-inflammatory cells can participate in the pathogenesis of KS such as eosinophils, neutrophils and T lymphocytes [13,14] .…”

Section: Conflict Of Interest: No Conflicts Of Interest Have Been Decmentioning

confidence: 99%

Kounis syndrome secondary to heparin in a newborn with hypoplastic left heart.

Ortego¹,

Parada²,

Mariblanca³

et al. 2020

IBJ Clin Pharmacol

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Kounis syndrome (KS) is an acute coronary syndrome (ACS) described in relationship with drugs or stents. KS was suspected in a full-term newborn who underwent a Rashkind-atrioseptostomy and stenting that periodically developed episodes of ACS. Skin test with nickel and titanium were performed being negatives. Basophil activation (BAT) and lymphocyte transformation (LTT) tests were performed for the suspected drugs. Non-responder basophils in BAT and a positive LTT for heparin were found. A new dose of heparin was administered by error, after which a new ACS was developed. We described the first report of KS by drug in a newborn.

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“…3. The patient reported developed severe anaphylaxis without skin manifestations that could have rendered the diagnosis of anaphylaxis difficult [9]. However, there are reports of severe anaphylaxis without skin involvement, and this has been attributed to shock due to reduced cardiac output from leakage of plasma and volume loss that reduces venous return and prevents or delays the released anaphylactic mediators from reaching and acting on the skin, thus inducing redness, rash, and/ or itching [10].…”

Section: Mast Cells and Basophils Carry Surface Receptors Formentioning

confidence: 99%

“Too Many Cooks Spoil the Broth”: The More Antigens Present, the Easier, the Quicker, and the More Severe the Anaphylaxis

Kounis

Koniari

Velissaris

et al. 2019

J Investig Allergol Clin Immunol

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a 62-year-old woman who experienced an anaphylactic reaction during cataract surgery after intravenous administration of cefuroxime and methylprednisolone. The patient had been receiving 9 different medications before surgery. While not atopic, she had alcoholism, idiopathic hypertension, dyslipidemia, chronic obstructive pulmonary disease, and osteoporosis. One month later, while undergoing a skin prick test with cephalosporins, which was strongly positive for cefuroxime, the patient began to experience severe dyspnea, oropharyngeal tightness, severe bronchospasm, cyanosis, loss of consciousness, and acute elevation of serum tryptase levels with absence of skin manifestations. She was treated with intense antiallergic therapy and respiratory life support.This report raises major issues concerning the risks of skin prick testing, the use of polypharmacy, and anaphylaxis without skin manifestations.1. The frequency of allergic, hypersensitivity, or anaphylactic reactions in patients with a high likelihood of allergy after skin testing is as high as 10% [2]. The authors stated that their case was the only case in the English-language literature of a severe systemic reaction induced by skin prick testing with a cephalosporin. However, we previously reported a case of anaphylaxisassociated acute coronary Kounis syndrome following skin tests (prick tests and intradermal tests) with amoxicillin [3]. The patient in question was a 71-year-old hypertensive man with a history of physical discomfort, vomiting, and generalized hives within minutes of taking an amoxicillin tablet 3 years previously. Approximately 10 minutes after the intradermal tests with amoxicillin, the findings recorded were a papule (9 × 8 mm), physical discomfort, generalized itching, dizziness, hypotension, bowel incontinence, and oppression of the epigastrium. Electrocardiographic changes were recorded in the anterolateral leads, with elevation of troponin and serum tryptase. The specific IgE determinations against ß-lactams (penicillin G, penicillin V, amoxicillin, and ampicillin) that were carried out 2 weeks later yielded positive results (0.35 kU/L) to amoxicillin only. Mast cells and basophils carry surface receptors forimmunoglobulin E (IgE) antibodies. When allergens such as drugs, metal anions, polymers, latex, disinfectants, and infusion materials bridge their corresponding receptor bound IgE antibodies, then mast cells and basophils degranulate and release their inflammatory mediators.

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Kounis syndrome caused by anaphylaxis without skin manifestations after cefazolin administration

Cited by 26 publications

References 8 publications

Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

Plaque Rupture-Induced Myocardial Infarction and Mechanical Circulatory Support in Alpha-Gal Allergy

Kounis syndrome secondary to heparin in a newborn with hypoplastic left heart.

“Too Many Cooks Spoil the Broth”: The More Antigens Present, the Easier, the Quicker, and the More Severe the Anaphylaxis

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