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Kounis Syndrome — also known as "allergic angina" or "allergic myocardial infarction" — is a rare but potentially serious medical condition in which an allergic reaction triggers an acute coronary syndrome (ACS). This means that an allergic or hypersensitivity reaction leads to coronary artery spasm, plaque rupture, or stent thrombosis, resulting in chest pain or even a heart attack.
🔍 Pathophysiology:
The underlying mechanism involves the release of inflammatory mediators like:
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Histamine
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Leukotrienes
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Prostaglandins
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Tryptase
These substances cause coronary artery vasospasm or promote thrombus formation in susceptible individuals.
🧬 Types of Kounis Syndrome:
Kounis Syndrome is categorized into three types:
| Type | Description |
|---|---|
| Type I | Occurs in patients with normal coronary arteries; allergic reaction causes coronary spasm without underlying atherosclerosis. |
| Type II | Occurs in patients with pre-existing atherosclerotic coronary disease; allergic mediators trigger plaque rupture or erosion. |
| Type III | Involves coronary stent thrombosis triggered by an allergic reaction, often to stent components or drugs (e.g., drug-eluting stents). |
⚠️ Triggers:
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Drugs: Antibiotics (penicillin), NSAIDs, contrast media
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Insect stings: Bee or wasp stings
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Foods: Nuts, shellfish
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Environmental allergens: Latex, pollen
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Medical materials: Stents, anesthetics
🧪 Diagnosis:
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ECG: May show ischemic changes (ST elevation, T wave inversion)
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Cardiac biomarkers: Elevated troponins
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Eosinophilia, serum tryptase, and IgE may be elevated (indicating allergic reaction)
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Coronary angiography: Helps differentiate type I (normal arteries) vs. type II (plaque rupture)
🩺 Management:
Treatment involves both anti-allergic and cardiac management:
Anti-allergic:
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Antihistamines (H1 and H2 blockers)
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Corticosteroids
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Epinephrine (with caution — it can worsen coronary spasm)
Cardiac:
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Nitrates, calcium channel blockers (for vasospasm)
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Antiplatelets, statins (for atherosclerosis-related cases)
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Avoidance of allergen (long-term)
🔄 Differential Diagnosis:
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Acute coronary syndrome not related to allergy
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Anaphylaxis without cardiac involvement
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Myocarditis
📌 Key Points:
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Kounis Syndrome represents an intersection of cardiology and immunology.
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It’s underdiagnosed, often mistaken for typical ACS.
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High clinical suspicion is needed when a patient develops chest pain during or after an allergic reaction.
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