Kounis Syndrome and Allergic Cardiovascular Events
Summary
Kounis syndrome represents the concurrence of acute coronary events and hypersensitivity reactions, in which allergic mediators precipitate coronary vasospasm, plaque erosion or thrombosis. This syndrome encompasses three clinical variants: Type I, occurring in patients with angiographically normal coronary arteries; Type II, arising in those with pre-existing atheromatous disease; and Type III, manifesting as in-stent thrombosis or restenosis. Central to its pathophysiology is mast cell activation and degranulation, leading to release of histamine, leukotrienes, cytokines and platelet-activating factors. Triggers range from drugs and foods to insect venoms and radiological contrast agents. Clinically, patients present with chest pain, electrocardiographic changes and elevated cardiac biomarkers in the setting of allergic signs such as urticaria or hypotension. Global under-recognition of the condition has driven research towards improved diagnostic biomarkers, integration of allergy and cardiology protocols, and exploration of therapies that stabilise mast cells or block key mediators without compromising cardiovascular support.
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Kounis Syndrome and Allergic Cardiovascular Events publication trend
The graph below shows the total number of articles in kounis syndrome and allergic cardiovascular events across all publications each year (not limited to Nature Index journals).
Technical terms
Mast cell: A immune cell laden with granules containing histamine and other mediators that, upon degranulation, can promote inflammation and vasomotor changes.
Anaphylaxis: A severe systemic allergic reaction characterised by rapid onset of hypotension, bronchospasm, rash and risk of circulatory collapse.
Vasospasm: Transient constriction of a blood vessel leading to reduced blood flow, often implicated in chest pain and myocardial ischaemia.
Acute coronary syndrome: A spectrum of conditions, including unstable angina and myocardial infarction, resulting from sudden reduction in coronary blood flow.
References
- Kounis Syndrome: not a Single Organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Medical Journal (2019).
- An Insight into Kounis Syndrome: Bridging Clinical Knowledge with Forensic Perspectives. Life (2024).
- Case report: Cefoperazone-sulbactam induced Kounis syndrome and cardiogenic shock. Frontiers in Cardiovascular Medicine (2022).
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