title: Kounis syndrome: A concise review with focus on management.
abstract: Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event and was first described by Kounis and Zavras in 1991 as an allergic angina syndrome. Multiple causes have been described and most of the data in the literature are derived from the description of clinical cases - mostly in adult patients - and the pathophysiology remains only partly explained. Three different variants of Kounis syndrome have been defined: type I (without coronary disease) is defined as chest pain during an acute allergic reaction in patients without risk factors or coronary lesions in which the allergic event induces coronary spasm that electrocardiographic changes secondary to ischemia; type II (with coronary disease) includes patients with pre-existing atheromatous disease, either previously quiescent or symptomatic, in whom acute hypersensitive reactions cause plaque erosion or rupture, culminating in acute myocardial infarction; more recently a type-III variant of Kounis syndrome has been defined in patients with preexisting coronary disease and drug eluting coronary stent thrombosis. The pathogenesis of the syndrome is discussed, and a therapeutic algorithm is proposed.
authors.affiliation: UO Medicina, Ospedale San Jacopo, ASL3 Pistoia, Via Ciliegiole, 97, 51100 Pistoia, Italy. Electronic address: fassio.filippo@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Fassio
authors.affiliation: University of Foggia, Viale Pinto, 1, 71121 Foggia, Italy. Electronic address: losappiolaura@yahoo.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Losappio
authors.affiliation: Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Principe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Carretera Alcalá, Meco, s/n, 28805 Alcalá de Henares, Madrid, Spain. Electronic address: dario.antolin@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Antolin-Amerigo
authors.affiliation: U.O.s.D. Allergologia, Ospedale Guglielmo Da Saliceto, Via Campagna, 68, Piacenza, Italy. Electronic address: silvia_peveri@yahoo.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Peveri
authors.affiliation: Servizio del Medico Competente, Azienda Sanitaria Locale di Sassari, via Catalocchino 11, 07100 Sassari, Italy. Electronic address: giannipalass@libero.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pala
authors.affiliation: IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese (MI), Italy. Electronic address: dpreziosi@libero.it.
authors.forename: Donatella
authors.initials: D
authors.lastname: Preziosi
authors.affiliation: Centro di Ricerca, Trasferimento ed Alta Formazione Denothe, Università di Firenze, Viale Pieraccini, 6, Firenze, Italy. Electronic address: massaroilaria81@gmail.com.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Massaro
authors.affiliation: UO Cardiologia, Ospedale San Giovanni di Dio, via di Torregalli 3, 50143 Firenze, Italy. Electronic address: giuliani.gabriele@gmail.com.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giuliani
authors.affiliation: UO Anestesia e Rianimazione, Ospedale San Jacopo, ASL3 Pistoia, Via Ciliegiole, 97, 51100 Pistoia, Italy. Electronic address: chiara.gasperini@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gasperini
authors.affiliation: UO Allergologia, Azienda Ospedaliero Universitaria Integrata, Piazzale Aristide Stefani, 1, Verona, Italy. Electronic address: m.caminati@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Caminati
authors.affiliation: Dipartimento di Medicina Clinica e Sperimentale, Pneumologia Riabilitativa e Allergologia, Università degli Studi di Catania, Via Santa Sofia 78, 95126 Catania, Italy. Electronic address: heffler.enrico@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Heffler
mesh_terms: D054058:Acute Coronary Syndrome / Q000145:classification / Q000150:complications* / Q000628:therapy*; D000787:Angina Pectoris / Q000209:etiology; D002637:Chest Pain / Q000209:etiology; D054855:Drug-Eluting Stents; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis* / Q000628:therapy
chemical_list: D006633:Histamine Antagonists
keywords: Allergic angina; Emergency; Hypersensitivity reaction; Kounis syndrome; Treatment