title: Hymenoptera sting-induced Kounis syndrome: effects of aspirin and beta-blocker administration.
abstract: Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with activation of interacting inflammatory cells including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It is caused via inflammatory mediators released during inflammatory cell activation. A variety of conditions, drugs, and environmental exposures can induce Kounis syndrome. A patient suffering from coronary artery disease and taking metoprolol and aspirin was stung by wasps and developed cutaneous allergic signs including rash, urticaria and orbital oedema. This was followed by retrosternal pain, chest discomfort and electrocardiographic changes compatible with acute myocardial ischemia. Cardiac enzymes, troponins and blood pressure remained normal but serum tryptase was raised. The clinical implications and pathophysiology of this rare association are discussed.
authors.forename: Tzanetos I
authors.initials: TI
authors.lastname: Ioannidis
authors.forename: Andreas
authors.initials: A
authors.lastname: Mazarakis
authors.forename: Stavros P
authors.initials: SP
authors.lastname: Notaras
authors.forename: Maria Z
authors.initials: MZ
authors.lastname: Karpeta
authors.forename: Asimina C
authors.initials: AC
authors.lastname: Tsintoni
authors.forename: George N
authors.initials: GN
authors.lastname: Kounis
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Rallis
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Kounis
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000276:immunology*; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy; D003329:Coronary Vasospasm / Q000276:immunology*; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications*; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000276:immunology*; D013577:Syndrome; D053802:Tryptases / Q000097:blood; D014581:Urticaria / Q000276:immunology; D014863:Wasps
chemical_list: D000319:Adrenergic beta-Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D053802:Tryptases; D008790:Metoprolol; D001241:Aspirin