Friend or foe: food-dependent exercise-induced anaphylaxis associated with acute coronary syndrome aggravated by adrenaline and aspirin: a case report

Abstract Background Although aspirin and adrenaline are the guideline-recommended treatments for acute coronary syndrome (ACS) and anaphylaxis, both regimens can contribute to clinical worsening in the setting of concurrent ACS and anaphylaxis which is called allergic angina or Kounis syndrome. Case summary A 62-year-old woman with food-dependent exercise-induced anaphylaxis developed ACS after intramuscular injection of adrenaline for the treatment of anaphylaxis, whereas administered aspirin for the treatment of ACS exacerbated anaphylaxis. Discussion Our case underlines the importance of tailored treatment based on the underlying pathophysiology of individual patients. Clopidogrel and glucagon might be a better alternative for the treatment of Kounis syndrome.

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Anaphylaxis from Wasp Stings Inducing Coronary Thrombus

Case Reports in Cardiology ◽

10.1155/2012/701753 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

Sazzli Kasim ◽

Rafidah AbuBakar ◽

Eugene McFadden

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Acute Coronary Syndromes ◽

Mast Cell Degranulation ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

Rare Manifestation ◽

Coronary Syndromes ◽

Wasp Stings ◽

Allergic Angina

Myocardial infarction as a result of wasp stings is a rare manifestation of acute coronary syndromes. It has been ascribed to kounis syndrome or allergic angina whose triggers include mast cell degranulation leading to coronary vasospasm and/or local plaque destabilisation. Its exact pathophysiology is still not clearly defined. We present a case of an acute coronary syndrome as a consequence of wasp stings and discuss its possible aetiology.

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KOUNIS SYNDROME - ALLERGIC MYOCARDIAL INFARCTION. A CASE REPORT

Wiadomości Lekarskie ◽

10.36740/wlek201901127 ◽

2019 ◽

Vol 72 (1) ◽

pp. 137-141

Author(s):

Olga Wajtryt ◽

Tadeusz M Zielonka ◽

Aleksandra Kaszyńska ◽

Andrzej Falkowski ◽

Katarzyna Życińska

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Allergic Reaction ◽

Anaphylactic Shock ◽

Coronary Artery Spasm ◽

Kounis Syndrome ◽

Permanent Damage ◽

Coronary Syndrome

Kounis syndrome or allergic myocardial infarction is an acute coronary syndrome in the course of an allergic reaction. In allergic patients in response to a specific condition - nourishment, inhalation, environmental substances, drug or insect bite there is an allergic reaction involving many different cells and mediators that can cause coronary artery spasm or initiate the process of rupture and activation of atherosclerotic plaque resulting in acute coronary syndrome. The paper describes a case of a young man with allergy to pollen and confirmed sensitization to nuts, who developed a full-blown anaphylactic shock after eating the nut mix and experienced a rapidly passing acute coronary syndrome with troponin up to 4.7 μg/L. An increased concentration of tryptase (15 μg/L), total IgE (> 3,000 IU/mL) and specific anti-nut IgE (55.1 kUA/L) were found. Based on the course of the disease and the results of allergic and cardiac tests, allergic type 1 myocardial infarction, i.e. caused by coronary artery spasm, was diagnosed. During the hospitalization, the patient’s condition improved quickly and after a few days he left the hospital without the signs of permanent damage to the heart muscle.

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An unusual case of concurrent Kounis syndrome and prolonged QT in a young patient

Cardiology in the Young ◽

10.1017/s1047951121003838 ◽

2021 ◽

pp. 1-3

Author(s):

Emrah Erdogan ◽

Murat Cap ◽

Gorkem Kus ◽

Cem Gokhan ◽

Yakup Kilic

Keyword(s):

Acute Coronary Syndrome ◽

Young Patient ◽

Unusual Case ◽

Allergic Reactions ◽

Kounis Syndrome ◽

Unique Case ◽

Coronary Syndrome ◽

Life Threatening ◽

Anaphylactoid Reactions ◽

Prolonged Qt

Abstract Allergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.

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Kounis syndrome uncovers severe coronary disease: an unusual case of acute coronary syndrome secondary to allergic coronary vasospasm

BMJ Case Reports ◽

10.1136/bcr-2019-232472 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232472

Author(s):

Luca Conti ◽

Kelly Gatt ◽

Christopher Zammit ◽

Karen Cassar

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

High Signal ◽

Type I ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

Triple Vessel Disease ◽

Appropriate Treatment ◽

St Elevation ◽

Type I Hypersensitivity

Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient’s eosinophil count returned to normal with improvement of clinical picture.

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Kounis syndrome (allergic acute coronary syndrome): different views in allergologic and cardiologic literature

Internal and Emergency Medicine ◽

10.1007/s11739-012-0754-4 ◽

2012 ◽

Vol 7 (6) ◽

pp. 489-495 ◽

Cited By ~ 31

Author(s):

Filippo Fassio ◽

Fabio Almerigogna

Keyword(s):

Acute Coronary Syndrome ◽

Kounis Syndrome ◽

Coronary Syndrome

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Coronary spasm secondary to cefuroxime injection, complicated with cardiogenic shock – a manifestation of Kounis syndrome: case report and literature review

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617701885 ◽

2017 ◽

Vol 7 (7) ◽

pp. 624-630 ◽

Cited By ~ 4

Author(s):

Andreas Mitsis ◽

Evi Christodoulou ◽

Panayiota Georgiou

Keyword(s):

Case Report ◽

Cardiogenic Shock ◽

Coronary Artery Spasm ◽

Coronary Spasm ◽

Haemodynamic Effect ◽

Atheromatous Plaque ◽

Type I ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

Allergic Angina

Kounis syndrome is defined as the coincidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic event. The three reported variants of Kounis syndrome are vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus. The syndrome is caused by various inflammatory mediators. The pathophysiological characteristics of Kounis syndrome involve coronary artery spasm and/or atheromatous plaque erosion or rupture during an allergic reaction. Several causes have been described to induce Kounis syndrome, and their number is increasing rapidly. The haemodynamic effect of the syndrome complicated by cardiogenic shock seems to combine allergic shock with extensive peripheral vasodilation and myocardial suppression with the characteristics of cardiogenic shock. Treatment of Kounis syndrome is challenging because it needs management of both cardiac and allergic manifestation simultaneously. We present a case report of type I Kounis syndrome, with coronary spasm secondary to cefuroxime injection complicated with cardiogenic shock. A brief review of the literature on the various facets of this condition is also provided.

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