Diagnosis And Management of Kounis Syndrome: A Narrative Review

An allergic reaction (hypersensitivity reaction) is any inappropriate response of the immune system to a normally harmless substance. Symptoms and organ damage may vary depending on factors that may trigger several proinflammatory mediators, such as allergens, host immune response, age, comorbidities, cofactors, and administrative treatment. When hypersensitivity inflammation and acute coronary syndrome combine, the result may be hypersensitivity coronary syndrome, which is referred to as Kounis syndrome (KS). KS is a group of cardiovascular symptoms ranging from acute coronary syndrome and/or allergic angina caused by an allergic reaction to allergens, such as insect venom, medications, contrast agents, and latex materials. KS has a common etiology, but it may be overlooked because a physician may focus on treating acute cardiac manifestations. Several studies have already proposed diagnostic criteria for KS. However, the lack of reports and research articles on cardiovascular manifestations with symptoms resembling acute coronary syndrome impedes the clinical diagnosis and management of KS. Clinicians must be aware of the possibility of KS as a symptom of acute or chronic allergic responses. In this review, the prevalence, pathomechanism, diagnostic approach, and treatment of KS have been addressed to increase the attention to acute coronary syndrome in the setting of allergy/anaphylaxis.