Allergic Acute Coronary Syndrome

Aka: Allergic Acute Coronary Syndrome, Kounis Syndrome, Allergic Angina

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II. Definitions

  1. Kounis Syndrome
    1. Acute Coronary Syndrome triggered by an Allergic Reaction

III. Epidemiology

  1. Seen in ~1% of patients admitted with Allergic Reaction

IV. Pathophysiology

  1. First described in 1991 by Nicholas Kounis
  2. Allergic Reaction cascade involving Mast Cell activation, Histamine release and Platelet aggregation
    1. Inflammatory reaction results in Coronary ArteryPlaque rupture resulting in Acute Coronary Syndrome
    2. Vasospasm may also be present

V. Findings

  1. Acute Coronary Syndrome onset within 1 hour of Allergic Reaction in 80% of cases

VI. Types

  1. Type 1: Vasospasm only
  2. Type 2: Vasospasm AND coronary thrombosis
  3. Type 3: Vasospasm AND stent thrombosis

VII. Management

  1. Manage as Acute Coronary Syndrome
  2. Manage Anaphylaxis
    1. Exercise caution with Anaphylaxis management that may provoke coronary disease (e.g. Epinephrine)
    2. Exercise caution with Acute Coronary Syndrome management that may provoke Allergic Reaction
      1. Beta Blockers may blunt Epinephrine response and Morphine (and other Opioids) may release Histamine

VIII. References

  1. Mattu and Demeester in Herbert (2021) EM:Rap 21(6): 3-4
  2. Kounis (1991) Br J Clin Pract 45:121-8 [PubMed]
  3. Memon (2015) Proc (Bayl Univ Med Cent) 28(3):358-62 [PubMed]

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