Kounis syndrome is a condition that combines allergic,
hypersensitivity, anaphylactic or
anaphylactoid reactions with
acute coronary syndromes including vasospastic angina, acute
myocardial infarction and
stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of
mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning
Kounis syndrome therapy, pathophysiology,
clinical course and causality have been encountered during its
clinical course. Drugs that counteract
allergy, such as H2-antihistamines, can induce
allergy and
Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker
anaphylaxis and
Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce
anaphylactic reaction and
Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe
anaphylaxis manifesting as
Kounis syndrome. Commercially available
adrenaline saves lives in
anaphylaxis but it contains as preservative
sodium metabisulfite and should be avoided in the
sulfite allergic patients. Thus, careful patient past history and consideration for
drug side effects and
allergy should be taken into account before use. The decision to prescribe a
drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.