Angina following anaphylaxis: Kounis syndrome or adrenaline effect?

ABSTRACT

@#We have read with interest a report published in Malaysian Family Physician1 on a 23-year-old Malay atopic patient with a known allergy (angioedema) to metoclopramide, tramadol, aspirin, and CT contrast media who was stung by an insect and developed throat tightness, vomiting, and a swollen uvula. As he was being treated with intramuscular tetanus toxoid, intravenous hydrocortisone, intravenous chlorpheniramine, and 0.5mg (11000) of intramuscular adrenaline for anaphylactic shock, he presented, within minutes, with a sudden escalation of drowsiness, worsening throat tightness and chest pain so excruciating on his left side that he fainted. The patient’s electrocardiograms and cardiac enzymes were normal, however, and he regained consciousness with a high oxygen flow of 15 liters per minute. The following day, the patient was discharged in good condition. This report raises the issue of whether the excruciating chest pain was the result of the intramuscular adrenalin administration or of a Kounis Type I syndrome manifestation.