Kounis syndrome induced by contrast media: A case report and review of literature

Shibuya, Kazuhiko; Kasama, Shu; Funada, Ryuichi; Katoh, Hiroyuki; Tsushima, Yoshito

doi:10.1016/j.ejro.2019.02.004

Cited by 19 publications

(10 citation statements)

References 36 publications

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“…The low-osmolarity non-anionic contrast materials demonstrate lower side effects, at approximately 2.1%, compared to the anionic ones. However, mild symptoms that include fever, purpura, skin reactions, convulsions, dyspnea, renal damage, and the severe reactions such as hypersensitivity reactions including Kounis syndrome (72) and death (73) can be encountered during their use. Nonionic and dimeric contrast molecules bind to circulating proteins and create allergenic haptens to a lesser extent than the ionic and monomeric contrast materials.…”

Section: Radiology and Kounis Syndromementioning

confidence: 99%

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Kounis¹,

Koniari²,

Velissaris³

et al. 2019

Balkan Med J

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Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, postinflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high-and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multiorgan arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy-hypersensitivityanaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.

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Section: Radiology and Kounis Syndromementioning

confidence: 99%

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Kounis¹,

Koniari²,

Velissaris³

et al. 2019

Balkan Med J

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“…Literature also provides description of case reports of KS associated with ICM 1,2,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and with hymenoptera stings. [46][47][48][49][50][51][52][53][54] Note that only few subjects with KS related to drugs and hymenoptera stings underwent allergy tests, particularly STs, and presented positive results to the culprit drugs, specifically, amoxicillin, [55][56][57][58] ceftriaxone, 59 cefazolin, [60][61][62][63][64] cefuroxime, 65 ICM 37,44 or to hymenoptera venoms.…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Kounis syndrome: an underestimated emergency

Zisa¹,

Panero²,

Re³

et al. 2023

Eur Ann Allergy Clin Immunol

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Background: Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. Objectives:To establish the prevalence of KS among the patients with diagnosis of anaphylaxis and describe clinical features, cardiological and allergological outcomes of patients evaluated in our Allergy Outpatient Clinic. Methods: A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents.Results: We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to hymenoptera stings, 5/9 to drugs). Conclusions:The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

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“…Anaphylaxis affects mostly the skin together with an involvement of other organ systems, e.g., bronchospasm and wheezing, additional nausea and vomiting, or tachycardia and hypotension resulting in anaphylactic shock. An acute coronary syndrome caused by reduced blood flow to the heart may develop [17]. Maculopapular exanthem (MPE) of mild or moderate severity is by far the most common manifestation of NIHR [13•].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Diagnosing and Managing Patients with Reactions to Radiocontrast Media

Brockow

2021

Curr Treat Options Allergy

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Purpose of the review Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing. Recent findings Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers. Summary In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.

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Kounis syndrome induced by contrast media: A case report and review of literature

Cited by 19 publications

References 36 publications

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Kounis syndrome: an underestimated emergency

Diagnosing and Managing Patients with Reactions to Radiocontrast Media

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