Kounis Syndrome

About Kounis Syndrome:

• It is a rare medical condition where an allergic reaction triggers a heart problem.
• It is classified as a form of Acute Coronary Syndrome (ACS)–a term typically used for conditions like heart attacks–brought on by an allergic or hypersensitivity response.
• It is sometimes referred to as allergic angina or allergic myocardial infarction.
• It occurs when a person is exposed to a trigger–such as an insect sting, drug, or food–the body’s immune system activates mast cells, which release chemicals including histamine and cytokines. These substances:
  • Cause sudden spasm or tightening of coronary arteries
  • May rupture or erode existing plaque, worsening any blockages
  • Reduce blood flow to the heart, leading to ischemia (lack of oxygen) or infarction (tissue death)
• Types of Kounis Syndrome
  • Type I: Occurs in individuals with normal coronary arteries. The allergic reaction causes spasms, reducing blood flow and potentially leading to a heart attack.
  • Type II: Affects those with existing coronary disease. The allergic reaction destabilises plaques, causing rupture and a full heart attack.
  • Type III: Seen in patients with coronary stents. The allergic response may lead to clot formation within the stent.
• What can trigger it?
  • Insect stings or bites (such as bees and wasps)
  • Certain medications, particularly antibiotics and NSAIDs (painkillers)
  • Foods, such as shellfish, nuts, or kiwi
  • Environmental allergens such as latex or contrast dyes
  • Underlying health conditions like mastocytosis (a disorder involving excess mast cells)
• Symptoms: Chest pain, Rash, hives, or swelling (angioedema), shortness of breath or wheezing, low blood pressure, ECG changes such as ST-segment elevation or depression
• Treatment
  • For the allergic reaction: antihistamines, corticosteroids, and sometimes epinephrine is given
  • For the heart: standard cardiac care like oxygen, nitrates, and blood thinners.