ABSTRACT
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.
Subject(s)
Kounis Syndrome/complications , Kounis Syndrome/immunology , Humans , Kounis Syndrome/physiopathologySubject(s)
Blood Coagulation/immunology , COVID-19 , Cytokine Release Syndrome , Hypersensitivity/immunology , Kounis Syndrome , Anaphylaxis/immunology , Anaphylaxis/physiopathology , COVID-19/immunology , COVID-19/physiopathology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/immunology , Humans , Kounis Syndrome/immunology , Kounis Syndrome/physiopathology , Mast Cells , SARS-CoV-2 , Thrombosis/immunologyABSTRACT
BACKGROUND: Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. CASE PRESENTATION: A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. CONCLUSIONS: Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.
Subject(s)
Antibiotics, Antineoplastic/adverse effects , Epirubicin/adverse effects , Kounis Syndrome/etiology , Urinary Bladder Neoplasms/drug therapy , Antibiotics, Antineoplastic/administration & dosage , Epirubicin/administration & dosage , Humans , Iliac Artery , Injections, Intra-Arterial , Kounis Syndrome/diagnosis , Kounis Syndrome/drug therapy , Kounis Syndrome/immunology , Male , Middle Aged , Treatment OutcomeABSTRACT
Kounis Syndrome is defined as a hypersensitivity coronary disorder constituted by the association of an acute coronary syndrome with a hypersensitivity, allergic, anaphylactic or anaphylactoid reaction, in a pathophysiologic context involving mast-cells, platelets, eosinophils and various interacting inflammatory cells. Currently, Kounis Syndrome is established in the literature, as accompanied by a plethora of clinical case reports that further elucidate its aspects. To the best of our knowledge, a specific analysis regarding the pediatric data of Kounis Syndrome has never been performed. The aim of this review was to reveal all the pediatric Kounis Syndrome cases in the literature, in an attempt to define its clinical implications in children. Moreover, based on the data of this analysis, a new classification for Kounis Syndrome is proposed, focusing mainly in the presence or the absence of allergic myocardial infarction, as the central clinical feature for the stratification of the patients' clinical manifestations.
Subject(s)
Anaphylaxis , Kounis Syndrome/classification , Myocardial Infarction , Adolescent , Child , Child, Preschool , Female , Humans , Kounis Syndrome/immunology , MaleSubject(s)
Allergens/adverse effects , Allergens/immunology , Kounis Syndrome/etiology , Kounis Syndrome/immunology , Adult , Anti-Allergic Agents/therapeutic use , Blood Pressure/physiology , Dexamethasone/therapeutic use , Echocardiography , Electrocardiography , Humans , Immunoglobulin E/metabolism , Male , Promethazine/therapeutic use , Tachycardia, Sinus/etiology , Tachycardia, Sinus/immunologySubject(s)
Coronary Vasospasm/diagnosis , Coronary Vessels/physiopathology , Kounis Syndrome/diagnosis , Vasoconstriction , Adrenal Cortex Hormones/therapeutic use , Anti-Allergic Agents/therapeutic use , Coronary Vasospasm/drug therapy , Coronary Vasospasm/immunology , Coronary Vasospasm/physiopathology , Coronary Vessels/drug effects , Coronary Vessels/immunology , Electrocardiography , Humans , Kounis Syndrome/drug therapy , Kounis Syndrome/immunology , Kounis Syndrome/physiopathology , Male , Middle Aged , Risk Factors , Treatment Outcome , Vasoconstriction/drug effectsABSTRACT
BACKGROUND: Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions. METHODS: Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests. RESULTS: We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE-mediated hypersensitivity through positive skin tests to cefazoline has been proven in all patients. Two patients experienced systemic reactions during skin testing. All patients were successfully challenged with amoxicillin, and they tolerated cefuroxime. CONCLUSIONS: Cefazolin can be responsible for immediate severe allergic reactions in perioperative setting, including KS. Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. Our experience confirmed that patients with IgE-mediated hypersensitivity reactions to cefazolin can tolerate other beta-lactams. This selective pattern of clinical reactivity may be explained by its particular chemical structure, whose R1 side-chain is different from other beta-lactams.
Subject(s)
Anaphylaxis/diagnosis , Anti-Bacterial Agents/adverse effects , Cefazolin/adverse effects , Drug Hypersensitivity/diagnosis , Kounis Syndrome/diagnosis , Adult , Anaphylaxis/chemically induced , Anaphylaxis/immunology , Cross Reactions/immunology , Drug Hypersensitivity/immunology , Drug Hypersensitivity/pathology , Female , Humans , Kounis Syndrome/immunology , Kounis Syndrome/pathology , Male , Middle Aged , Perioperative Period , Skin Tests/methodsABSTRACT
Kounis syndrome (KS) consists of an association between hypersensitivity reactions triggered by various environmental and pharmacological factors and acute coronary syndromes. Blood supply may be compromised by either vasospasm (type I), native plaque destabilization (type II) or stent thrombosis (type III). Although the prognosis is generally favorable, treatment should include aggressive anti-thrombotic and anti-allergic therapies. A case compatible with type III KS, manifested as a macular rash followed by two episodes of stent thrombosis after primary angioplasty (PCI) of the right coronary artery is presented, and complemented by a review on the topic.
Subject(s)
Coronary Thrombosis/etiology , Kounis Syndrome/etiology , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Stents/adverse effects , Anti-Allergic Agents/therapeutic use , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/drug therapy , Coronary Thrombosis/immunology , Electrocardiography , Fibrinolytic Agents/therapeutic use , Humans , Kounis Syndrome/diagnostic imaging , Kounis Syndrome/drug therapy , Kounis Syndrome/immunology , Male , Middle Aged , Recurrence , Treatment OutcomeABSTRACT
A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. This patient also has a history of atopy giving a predisposition for developing IgE-mediated allergic reactions. Hymenoptera stings can be severe in atopic individuals and anaphylaxis may ensue. However, it is a rare cause of myocardial infarction (MI) (Kounis syndrome). Multiple wasp stings in the past may have contributed to sensitisation. Kounis syndrome is a rare clinical manifestation which should remain in the minds of physicians, especially with younger patients with no history of ischaemic heart disease or few risk factors.
