Kounis syndrome after almonds ingestion: From the diagnostic approach to new therapeutic options
Acute coronary syndromes can develop with an unusual and challenging presentation. Kounis syndrome is a mostly overlooked Acute Coronary Syndrome (ACS) in the setting of anaphylactic or anaphylactoid reactions in response to an allergic insult that can lead to severe complications including cardiac arrest. A 52-yearold- man presented to the emergency department of our hospital because of acute transient loss of consciousness that developed some minutes after almonds ingestion. The complex diagnostic workup led to the diagnosis of vasospastic Kounis syndrome, an infrequent type of acute coronary syndrome, mostly overlooked, with challenging diagnostic and therapeutic features. Peculiarities on clinical presentation, the approach adopted by the emergency physician and the consultant cardiologist to achieve the correct diagnosis and our proposed management with a brief revision of the literature will be reported. Unusual clinical presentations of acute coronary syndromes represent part of the pitfalls that an emergency physician can face during the everyday practice. Prompt identification of these conditions is always struggling but of crucial importance to improve patient prognosis with a correct diagnostic work-up and therapeutic management.
Rodrigues MC, Coelho D, Granja C. Drugs that may provoke Kounis syndrome. Braz J Anesthesiol 2013;63:426–8. DOI: https://doi.org/10.1016/j.bjane.2013.04.007
Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther 2013;35:563-71. DOI: https://doi.org/10.1016/j.clinthera.2013.02.022
Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract 1991;45:121–8.
Yanagawa Y, Sakamoto T, Okada Y. Lymphocytosis without anemia in a patient presenting with anaphylactic shock. Am J Emerg Med 2005;23:763-6. DOI: https://doi.org/10.1016/j.ajem.2005.04.007
Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2020:ehaa575. DOI: https://doi.org/10.1093/eurheartj/ehaa909
Rich MW. Is vasospastic angina an inflammatory disease? Am J Cardiol 2005;96:1612. DOI: https://doi.org/10.1016/j.amjcard.2005.02.061
Numasawa Y, Motoda H, Yamazaki H, et al. Successful treatment using corticosteroids in a patient with refractory vasospastic angina and bronchial asthma. J Cardiol Cases 2014;10:132-5. DOI: https://doi.org/10.1016/j.jccase.2014.06.008
Kounis NG, Koniari I, Velissaris D, et al. Kounis syndrome-not a single-organ arterial disorder but a multisystem and multidisciplinary disease. Balkan Med J 2019;36:212-21. DOI: https://doi.org/10.4274/balkanmedj.galenos.2019.2019.5.62
Berkes EA. Anaphylactic and anaphylactoid reactions to aspirin and other NSAIDs. Clin Rev Allergy Immunol 2003;24:137-48. DOI: https://doi.org/10.1385/CRIAI:24:2:137
Leung DYM, Sampson HA, Ynginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 2003;348:986-93. DOI: https://doi.org/10.1056/NEJMoa022613
Kaartinen M, Penttila A, Kovanen PT. Accumulation of activated mast cells in the shoulder region of human coronary atheroma, the prediction site of atheromatous rupture. Circulation 1994;90:1669-78. DOI: https://doi.org/10.1161/01.CIR.90.4.1669
Kounis NG, Koniari I, Tsigkas G, Davlouros P. Humanized monoclonal antibodies against IgE antibodies as therapy for IgE-mediated coronary syndromes: are we there yet? Can J Cardiol 2020;36:816-9. DOI: https://doi.org/10.1016/j.cjca.2020.01.008
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