Kounis Syndrome as First Manifestation of Allergic Sensitization

Mast cells are abundant in the heart, among myocardial fibers, around coronary arteries, within arterial intima and intramural vessels, and in atherosclerotic plaques. Their mediators can be released during anaphylaxis and be responsible for acute coronary syndrome. This condition has been described...

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Bibliographic Details
Published in:Case reports in medicine 2019-01, Vol.2019 (2019), p.1-5
Main Authors: Petrarca, Claudia, Paganelli, R., Di Giampaolo, L., Di Gioacchino, Mario, Farinelli, A., Della Valle, L., Gatta, A., Paloscia, L., Di Marco, M., D’Alleva, A., Scarano, G., Forlani, D., Lumaca, A.
Format: Article
Language:English
Subjects:
Allergic reaction
Allergies
Allergy
Anaphylaxis
Angina
Angina pectoris
Arteriosclerosis
Atherosclerosis
Biomarkers
Bites and stings
Blood pressure
Cardiac patients
Cardiovascular disease
Case Report
Case reports
Clopidogrel
Consciousness
Coronary artery
Coronary vessels
Emergency medical care
Family medical history
Heart
Hypersensitivity
Immunology
Ischemia
Mast cells
Medical imaging
Myocardial ischemia
Pain
Plaques
Thrombosis
Ticagrelor
Tryptase
Ultrasonic imaging
Urticaria
Venom
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Summary:Mast cells are abundant in the heart, among myocardial fibers, around coronary arteries, within arterial intima and intramural vessels, and in atherosclerotic plaques. Their mediators can be released during anaphylaxis and be responsible for acute coronary syndrome. This condition has been described as Kounis syndrome (KS). We report three cases of acute myocardial ischemia, which fulfill the definition for KS. In Cases 1 and 2, the association of intense chest pain with acute urticaria after an allergenic contact (wasp sting and betalactam antibiotic administration, respectively) was suspected to be an attack of angina related to an allergic reaction. No signs of an allergic reaction were observed in Case 3, but only the history of a wasp sting suggested its relationship to loss of consciousness and heart ischemia when hypersensitivity to venom was ascertained. These cases strongly recommend measurement of anaphylactic biomarkers, such as tryptase, during acute coronary syndromes to detect the possible involvement of an allergic reaction. Conversely, measurement of cardiac biomarkers during anaphylaxis, even without obvious signs of myocardial ischemia, might identify patients at risk of myocardial injury.
ISSN:1687-9627
1687-9635
DOI:10.1155/2019/6317956