Allergic Acute Coronary Syndrome: A Case Report and Literature Review
AJTES Volume 8, Number 1, January 2024
Hoxha M. et al. - Allergic Acute Coronary Syndrome. A Case Report and Literature Review

Keywords

Kounis Syndrome
allergic angina
hypersensitivity reaction

How to Cite

Hoxha, M., Ndreu, E., & Qirko Loloçi, E. (2024). Allergic Acute Coronary Syndrome: A Case Report and Literature Review. Albanian Journal of Trauma and Emergency Surgery, 8(1), 1413-1416. https://doi.org/10.32391/ajtes.v8i1.354

Abstract

Introduction: Kounis Syndrome was first described in 1991 by Kounis and Zavras as “the concurrence of chest pain during an allergic reaction, accompanied by clinical laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult” [1].

The mechanism of Kounis Syndrome most likely involves the release of cytokines through mast-cell degranulation, which leads to coronary vasospasm and atheromatous plaque erosion or rupture following the allergic reaction to an allergen.[2]

The treatment is specific to acute coronary syndrome and anaphylaxis, with the added complication that the drugs used, while indicated in each of the two disorders separately, may present contradictions when administered jointly in one patient.[3]

The purpose of this review is to briefly revise the existing literature regarding its overlooked diagnosis and contradictory joint management of anaphylaxis and acute coronary syndrome.

We will conduct a brief review of the current literature on Kounis Syndrome while describing a suspected case of a female patient presented with both anaphylaxis symptoms and angina pectoris.

Conclusions: Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic reaction. Treatment of allergic reactions may be sufficient in type I KS. In contrast, coronary intervention is needed in the other two types, accompanied by vasodilator drugs, including nitrates and calcium antagonists, each of which may have contradictory effects.

https://doi.org/10.32391/ajtes.v8i1.354
Hoxha M. et al. - Allergic Acute Coronary Syndrome. A Case Report and Literature Review

References

Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract. 1991 Summer;45(2):121-8. PMID: 1793697.

Kounis NG. Coronary hypersensitivity disorder: The Kounis syndrome. Clin Ther. 2013; 35:563–71.

Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int J Cardiol. 2006;110(1):7–14. [PubMed] [Google Scholar] [Ref list]

Rodrigues MC, Coelho D, Granja C. Drugs that may provoke Kounis syndrome. Braz J Anesthesiol. 2013;63(5):426–428. [PubMed] [Google Scholar] [Ref list]

Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol. 2010 Sep 3;143(3):223-6. doi: https://doi.org/10.1016/j.ijcard.2010.02.040 Epub 2010 Mar 4. PMID: 20206392.

Kounis NG (1 October 2016). "Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis, and therapeutic management." Clinical Chemistry and Laboratory Medicine. 54 (10): 1545–59. doi:10.1515/cclm-2016-0010. PMID 26966931. S2CID 11386405.

Abdelghany M, Subedi R, Shah S, et al. Kounis syndrome: A review article on epidemiology, diagnostic findings, management, and allergic acute coronary syndrome complications. Int J Cardiol. 2017; 232:1 4. [PubMed] [Google Scholar] [Ref list]

Kounis NG, Mazarakis A, Tsigkas G, et al. Kounis syndrome: A new twist on an old disease. Future Cardiol. 2011; 7:805–824. [PubMed] [Google Scholar] [Ref list]

Giovannini M, Koniari I, Mori F, Ricci S, Simone LD, Favilli S, Trapani S, Indolfi G, Kounis N, Novembre E (2020-05-28). "Kounis syndrome: a clinical entity penetrating from pediatrics to geriatrics." Journal of Geriatric Cardiology. 17 (5): 294–299. doi:10.11909/j.issn.1671-5411.2020.05.011. PMC 7276306. PMID 32547613. Archived from the original on 2020-10-28, retrieved 2020-10-23.

Vivas, J.C. Rubira, A.F. Ortiz, C. Macaya. Coronary spasm and hypersensitivity to amoxicillin: Kounis or not Kounis syndrome? Int J Cardiol, 128 (2008), pp. 279-281 http://dx.doi.org/10.1016/j.ijcard.2007.06.029 | Medline

Nicholas.G. Kounis. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int J Cardiol, 110 (2006), pp. 7-14 http://dx.doi.org/10.1016/j.ijcard.2005.08.007 | Medline

Takagi S, Goto Y, Hirose E, et al. Successful treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation? Circ J 2004;68:17-22 [PubMed] [Google Scholar] [Ref list]

Sebaldt RJ, Sheller JR, Oates JA, et al. Inhibition of eicosanoid biosynthesis by glucocorticoid in humans. Proc Natl Acad Sci USA 1990;87:6974-8 [PMC free article] [PubMed] [Google Scholar] [Ref list]

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