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Kounis Syndrome

MedGen UID:
1380779
•Concept ID:
C2609176
•
Disease or Syndrome
Synonyms: Allergic Acute Coronary Syndrome; Allergic Angina Syndrome; Allergic Angina Syndromes

Definition

A disorder of cardiac function secondary to hypersensitivity reactions. It is characterized by coexistence of acute coronary syndromes and cardiac MAST CELL and PLATELET ACTIVATION. It may be induced by exposure to drugs (e.g., antibiotics, anesthetics, contrast media), food, and environmental triggers (e.g., insect bites and stings, poison ivy). [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVKounis Syndrome

Professional guidelines

PubMed

Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome.
Abdelghany M, Subedi R, Shah S, Kozman H
Int J Cardiol 2017 Apr 1;232:1-4. Epub 2017 Jan 27 doi: 10.1016/j.ijcard.2017.01.124. PMID: 28153536
Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management.
Kounis NG
Clin Chem Lab Med 2016 Oct 1;54(10):1545-59. doi: 10.1515/cclm-2016-0010. PMID: 26966931
Treatment of Kounis syndrome.
Cevik C, Nugent K, Shome GP, Kounis NG
Int J Cardiol 2010 Sep 3;143(3):223-6. Epub 2010 Mar 4 doi: 10.1016/j.ijcard.2010.02.040. PMID: 20206392

Recent clinical studies

Etiology

Kounis syndrome: an underestimated emergency.
Zisa G, Panero A, Re A, Mennuni MG, Patti G, Pirisi M
Eur Ann Allergy Clin Immunol 2023 Nov;55(6):294-302. Epub 2022 Jul 18 doi: 10.23822/EurAnnACI.1764-1489.260. PMID: 35850501
Mast Cells in Cardiovascular Disease: From Bench to Bedside.
Hermans M, Lennep JRV, van Daele P, Bot I
Int J Mol Sci 2019 Jul 10;20(14) doi: 10.3390/ijms20143395. PMID: 31295950Free PMC Article
Kounis syndrome: A concise review with focus on management.
Fassio F, Losappio L, Antolin-Amerigo D, Peveri S, Pala G, Preziosi D, Massaro I, Giuliani G, Gasperini C, Caminati M, Heffler E
Eur J Intern Med 2016 May;30:7-10. Epub 2016 Jan 12 doi: 10.1016/j.ejim.2015.12.004. PMID: 26795552
Anaphylaxis and cardiovascular disease: therapeutic dilemmas.
Lieberman P, Simons FE
Clin Exp Allergy 2015 Aug;45(8):1288-95. doi: 10.1111/cea.12520. PMID: 25711241
Coronary stent thrombosis: beware of an allergic reaction and of Kounis syndrome.
Kounis NG, Soufras GD
Indian Heart J 2014 Mar-Apr;66(2):153-5. Epub 2013 Dec 26 doi: 10.1016/j.ihj.2013.12.013. PMID: 24814107Free PMC Article

Diagnosis

Allergic Acute Coronary Syndrome-Kounis Syndrome.
Alblaihed L, Huis In 't Veld MA
Immunol Allergy Clin North Am 2023 Aug;43(3):503-512. doi: 10.1016/j.iac.2022.10.010. PMID: 37394256
Epirubicin-induced Kounis syndrome.
Liang HZ, Zhao H, Gao J, Cao CF, Wang WM
BMC Cardiovasc Disord 2021 Mar 12;21(1):133. doi: 10.1186/s12872-021-01936-4. PMID: 33711934Free PMC Article
Intimate Contact Could Be Dangerous for Your Health.
Kounis NG, Ren HL, Kavalioti M, Koniari I, Theoharides TC
Clin Ther 2019 Jun;41(6):1222-1226. Epub 2019 May 7 doi: 10.1016/j.clinthera.2019.04.010. PMID: 31076202
Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome.
Abdelghany M, Subedi R, Shah S, Kozman H
Int J Cardiol 2017 Apr 1;232:1-4. Epub 2017 Jan 27 doi: 10.1016/j.ijcard.2017.01.124. PMID: 28153536
Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management.
Kounis NG
Clin Chem Lab Med 2016 Oct 1;54(10):1545-59. doi: 10.1515/cclm-2016-0010. PMID: 26966931

Therapy

Epirubicin-induced Kounis syndrome.
Liang HZ, Zhao H, Gao J, Cao CF, Wang WM
BMC Cardiovasc Disord 2021 Mar 12;21(1):133. doi: 10.1186/s12872-021-01936-4. PMID: 33711934Free PMC Article
Carboplatin-Induced Kounis Syndrome.
Tambe V, Tambe A, Goodman A, Shepherd Z
Am J Ther 2020 Nov/Dec;27(6):e647-e652. doi: 10.1097/MJT.0000000000001027. PMID: 31567140
Vancomycin-induced Kounis Syndrome.
Leibee C, Getachew B, Ehmann MR
Am J Emerg Med 2019 Sep;37(9):1806.e3-1806.e5. Epub 2019 Jun 3 doi: 10.1016/j.ajem.2019.06.004. PMID: 31182359
Ampicillin/sulbactam-induced Kounis syndrome with cardiogenic shock.
Kounis NG, Koniari I
Anatol J Cardiol 2017 Feb;17(2):154-155. doi: 10.14744/AnatolJCardiol.2016.7612. PMID: 28209929Free PMC Article
Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome.
Abdelghany M, Subedi R, Shah S, Kozman H
Int J Cardiol 2017 Apr 1;232:1-4. Epub 2017 Jan 27 doi: 10.1016/j.ijcard.2017.01.124. PMID: 28153536

Prognosis

Anaphylaxis-induced atrial fibrillation and anesthesia: Pathophysiologic and therapeutic considerations.
Kounis NG, Koniari I, Tzanis G, Soufras GD, Velissaris D, Hahalis G
Ann Card Anaesth 2020 Jan-Mar;23(1):1-6. doi: 10.4103/aca.ACA_100_19. PMID: 31929239Free PMC Article
Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome.
Abdelghany M, Subedi R, Shah S, Kozman H
Int J Cardiol 2017 Apr 1;232:1-4. Epub 2017 Jan 27 doi: 10.1016/j.ijcard.2017.01.124. PMID: 28153536
Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management.
Kounis NG
Clin Chem Lab Med 2016 Oct 1;54(10):1545-59. doi: 10.1515/cclm-2016-0010. PMID: 26966931
Foods, Drugs and Environmental Factors: Novel Kounis Syndrome Offenders.
Kounis NG, Giannopoulos S, Soufras GD, Kounis GN, Goudevenos J
Intern Med 2015;54(13):1577-82. Epub 2015 Jul 1 doi: 10.2169/internalmedicine.54.3684. PMID: 26134186
Current understanding of Kounis syndrome.
Biteker M
Expert Rev Clin Immunol 2010 Sep;6(5):777-88. doi: 10.1586/eci.10.47. PMID: 20828286

Clinical prediction guides

Kounis Syndrome: Review of Clinical Cases.
Yakushin S, Gurbanova A, Pereverzeva K
Cardiovasc Hematol Disord Drug Targets 2024;24(2):83-97. doi: 10.2174/011871529X305833240708051508. PMID: 39021170
Angina and Arrhythmia Symptoms Following Multiple Bee Stings: Kounis Syndrome.
Acehan S, Satar S, Gulen M, Yucel C, Segmen MS
Wilderness Environ Med 2022 Dec;33(4):417-421. Epub 2022 Sep 13 doi: 10.1016/j.wem.2022.06.003. PMID: 36109267
Clinico-epidemiology of Hypnale zara (hump-nosed pit viper) envenoming in Sri Lanka.
Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM
Trans R Soc Trop Med Hyg 2021 Jun 2;115(6):603-612. doi: 10.1093/trstmh/trab065. PMID: 33948662
Kounis syndrome. Apropos of a clinical case.
Duarte P, Costa J, Serena C, Almeida C, Gouveia S, Lourenço C, Costa H, Paiva C
Rev Bras Ter Intensiva 2020 Mar;32(1):149-152. Epub 2020 May 8 doi: 10.5935/0103-507x.20200021. PMID: 32401974Free PMC Article
White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease.
Kounis NG, Soufras GD, Tsigkas G, Hahalis G
Clin Appl Thromb Hemost 2015 Mar;21(2):139-43. Epub 2014 Apr 24 doi: 10.1177/1076029614531449. PMID: 24770327

Recent systematic reviews

Clinical characteristics, management, diagnostic findings, and various etiologies of patients with Kounis syndrome. A systematic review.
Cahuapaza-Gutierrez NL, Calderon-Hernandez CC, Chambergo-Michilot D, De Arruda-Chaves E, Zamora A, Runzer-Colmenares FM
Int J Cardiol 2025 Jan 1;418:132606. Epub 2024 Oct 1 doi: 10.1016/j.ijcard.2024.132606. PMID: 39362367
Perioperative Presentations of Kounis Syndrome: A Systematic Literature Review.
Dai B, Cavaye J, Judd M, Beuth J, Iswariah H, Gurunathan U
J Cardiothorac Vasc Anesth 2022 Jul;36(7):2070-2076. Epub 2022 Jan 31 doi: 10.1053/j.jvca.2022.01.042. PMID: 35260322
Kounis Syndrome: a pediatric perspective.
Giovannini M, Alletto A, Koniari I, Mori F, Favilli S, Sarti L, Barni S, Liccioli G, Lodi L, Indolfi G, Novembre E, Kounis NG
Minerva Pediatr 2020 Oct;72(5):383-392. Epub 2020 Sep 22 doi: 10.23736/S0026-4946.20.06007-7. PMID: 32960008
Systemic Mastocytosis, Kounis Syndrome and Coronary Intervention: Case Report and Systematic Review.
Paratz ED, Khav N, Burns AT
Heart Lung Circ 2017 Aug;26(8):772-778. Epub 2017 Feb 15 doi: 10.1016/j.hlc.2016.12.009. PMID: 28242292

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