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Last update 08 May 2025

Kounis Syndrome

Last update 08 May 2025

Basic Info

Synonyms

Allergic Acute Coronary Syndrome, Allergic Angina Syndrome, Allergic Angina Syndromes

+ [5]

Introduction

A disorder of cardiac function secondary to hypersensitivity reactions. It is characterized by coexistence of acute coronary syndromes and cardiac MAST CELL and PLATELET ACTIVATION. It may be induced by exposure to drugs (e.g., antibiotics, anesthetics, contrast media), food, and environmental triggers (e.g., insect bites and stings, poison ivy).

Clinical Trials associated with Kounis Syndrome

NL-OMON20739

/ SuspendedNot Applicable

ILIAS ANOCA

Start Date01 Jun 2021

Sponsor / Collaborator-

NCT04485234

/ CompletedNot ApplicableIIT

Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry)

This study evaluates the prognostic value and potential therapeutic impact of combined pressure and flow measurements in the evaluation of epicardial coronary stenosis and microvascular function.

Start Date01 Jun 2019

Sponsor / Collaborator

Academic Medical Center University of Amsterdam

[+11]

TCTR20180321001

/ RecruitingPhase 4

A randomized, double-blinded, controlled trial of adding a short burst of corticosteroid to the conventional treatment of H1 antihistamines

Start Date20 Sep 2017

Sponsor / Collaborator

Rachada Chemicals Co. Ltd.

100 Clinical Results associated with Kounis Syndrome

100 Translational Medicine associated with Kounis Syndrome

0 Patents (Medical) associated with Kounis Syndrome

895

Literatures (Medical) associated with Kounis Syndrome

01 Jul 2025·International Journal of Cardiology

Cephalosporin triggered Kounis syndrome: Pathophysiological and clinical insights

Article

Author: Giannino, Federico ; Granata, Lucio ; Andò, Giuseppe ; Cimino, Claudia ; Raspanti, Davide ; Kounis, Nicholas G ; Koniari, Ioanna ; de Gregorio, Cesare

BACKGROUNDAcute coronary syndrome triggered by hypersensitivity to various natural, chemical, or pharmaceutical allergens is known as Kounis syndrome. Kounis syndrome is classified in three subtypes based on its pathophysiological mechanism and outcome. Among pharmaceuticals, cephalosporins are frequently implicated in allergic illnesses, with ceftriaxone being one of the most frequently reported causes. Based on literature reports and our own experience, we focused on the main clinical features regarding ceftriaxone triggered KS (CTKS).METHODSMedical records from all CTKS cases, as published by the end of December 2024, were retrieved and analyzed, including a patient admitted to our hospital after inadvertent twice ceftriaxone administration.RESULTSClinical findings from 10 CTKS patients, mean aged 61 ± 18 (range 24-85) years, 5 males, were studied. Type-I KS (coronary vasospasm) was found in 8 cases (80 %), whereas 2 more patients showed a type-II variant (atheromatous plaque thrombosis), with the right artery as the most involved coronary vessel. Apart from transient hemodynamic instability in 2 patients on admission, everyone was discharged in a good clinical condition.CONCLUSIONSCTKS is a rare, but likely underrecognized, clinical condition that may occur regardless of gender, age, history of allergy or preexisting coronary artery disease. The predominant type-I variant indicates a transient coronary asospasm (and/or microcirculatory impairment) as the most likely pathogenic mechanism. Key pathophysiological, clinical, and prognostic aspects are discussed.

01 Jun 2025·European Journal of Radiology

Very rare adverse reactions to intravascular contrast media: From Kounis to sweet syndrome

Review

Author: Laguna, José J ; Vega, Francisco ; van der Molen, Aart J ; van de Ven, Annick A J M

Intravascular administration of contrast media may inadvertently result in adverse drug reactions (ADR) including selected hypersensitivity reactions. This review highlights some very rare ADR, aiming to alert imaging physicians to these conditions and to prompt adequate management. This is particularly relevant for Kounis syndrome, an immediate hypersensitivity reaction involving the coronary arteries. The acute management of Kounis syndrome can be challenging, as it requires continued contrast media administration, while balancing the simultaneous coronary reperfusion that requires vasodilatation with anti-allergic treatment that may involve vasoconstrictor agents. For other adverse reactions, referral to a drug allergy specialist is highly recommended to assess causality and identify safe alternatives. CLINICAL RELEVANCE STATEMENT: Cardiologists and radiologists must recognize the key symptoms of these very rare adverse reactions to contrast media to promptly initiate the appropriate therapy and refer patients for allergological evaluation, ideally within 1-6 months after the reaction.

01 Jun 2025·International Journal of Cardiology

Reply to “formal case-definition for Kounis syndrome”

Letter

Author: Calderon-Hernandez, Cielo Cinthya ; Cahuapaza-Gutierrez, Nelson Luis ; Runzer-Colmenares, Fernando M

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