Kounis Syndrome

A New Twist on an old Disease

Nicholas G Kounis; Andreas Mazarakis; Grigorios Tsigkas; Sotiris Giannopoulos; John Goudevenos


Future Cardiol. 2011;7(6):805-824. 

In This Article

Symptoms & Signs of Kounis Syndrome

The main clinical symptoms and signs of Kounis syndrome are always associated with subclinical, clinical, acute or chronic allergic reactions accompanied by cardiac symptomatology. These symptoms and signs are accompanied by electrocardiographic changes (Box 3). A high index of suspicion regarding this syndrome is of paramount importance. Although it is not a rare disease its diagnosis is easily overlooked.[43] Kounis syndrome cases, although under reported, are more often encountered in clinical practice and it is anticipated that many more causative factors will be implicated in the future. In the district of Achaia, Greece with a population of 300,000 inhabitants, 20 cases of Kounis syndrome have been encountered in the last 2 years caused by environmental exposures, drug allergies and stent implantation. Kounis syndrome has mostly been reported in southeastern Europe, especially Greece and Turkey. This geographical variation could be attributed to the following reasons: increased awareness of physicians of the existence of Kounis syndrome, climate and environmental conditions, resulting in pollen cross-reactivities and hymenoptera exposures, overconsumption of medicines, or inadequacy of preventative measures. Gene–environment interactions starting in early life using the epigenetic approach should be also explored too.

In any case of acute coronary syndrome, careful patient questioning may reveal a mechanism involving mast cell activation to precede the event. Routine cardiac evaluation for myocardial injury biomarkers, such as cardiac enzymes including CPK-MB and troponins, together with histamine and tryptase levels should be undertaken in any patient with any grading of allergic reaction.[44] Chest symptoms, angina pectoris, recurrent myocardial infarction or sudden death in patients with stent implantation either in hospital or in the real world should also be considered as Kounis syndrome symptomatology.[45]


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