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Understanding Kounis Syndrome In Detail – A Medical Guide

Posted On: Sep 14, 2023

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Kounis Syndrome : Types, Causes and Symptoms

A 31-year-old male was brought to Manipal Hospital Whitefield’s emergency department, complaining of rashes on both arms, itching for 12 hours, severe chest discomfort, and dizziness, following refined wheat flour bread (maida paratha) consumption the previous night. After a thorough evaluation at the hospital, he was diagnosed with Type 1 Kounis Syndrome – a hypersensitivity disorder that is known to cause heart-related problems and can become fatal if not treated on time.

What Did the Patient Suffer from?

Many people suffer from hypersensitivity reactions including the patient visiting the ER with severe chest discomfort associated with rashes. It arises due to immunological dysfunction or an exaggerated or inappropriate immune system response to an allergen. There are 4 types of hypersensitivity reactions (Type I to Type 4). 

Type I hypersensitivity or allergy is the most common immune disorder. It can cause anaphylaxis, food allergy, and asthma. Anaphylaxis (severe, whole-body allergic reaction) is an instant response to an allergy. It can cause narrowing of the blood vessels that supply oxygen to your heart muscle (severe coronary vasospasms), leading to acute coronary diseases. Anaphylaxis virtually affects all major systems of the body, making the heart one of its target organs. This understanding of hypersensitivity reactions in the patient aligns with the diagnosis of Kounis syndrome. 

What Is Kounis Syndrome?

Kounis syndrome is a rare hypersensitivity reaction which affects the coronary arteries. The body releases inflammatory mediators in response to an allergic stimulus. This mysterious condition often goes under the radar, yet it can have serious consequences for those affected. It can lead to serious and potentially life-threatening cardiac events such as angina or even myocardial infarction (heart attack). 

Kounis syndrome can affect people of any age group (2 to 90 years) but is most common among people in 30 to 70 years of age. According to reports, the incidence of Kounis syndrome varies from 7.9 to 19.4 per 100,000 people.

Types of Kounis Syndrome

There are 3 types of Kounis syndrome:

  • Type I

It can happen to people with structurally normal coronary arteries with no cardiovascular risk factors. The acute release of inflammatory mediators can cause narrowing of the arteries (vasospasm), which may or may not result in a heart attack

  • Type II

This occurs in patients with pre-existing coronary artery disease. The release of inflammatory mediators causes the narrowing of the arteries. This results in plaque rupture and heart attack.

  • Type III

This occurs in patients with a coronary artery stent. The release of inflammatory mediators may result in occlusion of the coronary stent (stent thrombosis). 

Acute coronary syndrome typically starts within 1 hour of exposure to the allergen; longer onset times have also been reported. 

So, Did the Patient Have Any Pre-existing Risk Factors?

The patient did not have any known coronary risk factors. He was a non-smoker and had no family history of coronary artery disease. However, his background history included an allergy to chicken and seafood. He also had a history of occasionally developing rashes on his arms after consuming wheat flour. 

His Cardiovascular and Respiratory Examinations were Normal

Other than his blood pressure being on the lower side, the patient had a normal pulse rate, respiration rate, and jugular venous pulse (JVP) with no symptoms of fever. His cardiovascular and respiratory examinations showed normal functioning of the heart and lungs.

Symptoms of Kounis Syndrome

The symptoms of Kounis syndrome include:

  • Allergic symptoms

  • Urticarial rashes 

  • Itching & Redness

  • Swelling

Cardiovascular Symptoms 

Other symptoms

Visit a top cardiology hospital if you are experiencing Kounis Syndrome symptoms. 

What Causes Kounis Syndrome?

Various factors cause Kounis syndrome; these include certain medicines or drugs (anticoagulants, antibiotics, analgesics, anaesthetics, etc.), food products (fishes, vegetables, mushrooms, etc.), environmental factors (latex contact, millet allergy, grass cutting, etc.), presence of a condition, etc.

How is Kounis Syndrome Treated?

Treating Kounis syndrome is challenging because it needs to address both cardiac and allergic symptoms simultaneously. The treatment should comprise careful selection and use of medications to prevent further release of histamine or aggravation of coronary vasospasm.

Usually, a patient is first treated for anaphylaxis with antihistamines and corticosteroids and avoidance of triggers. Beta-blockers and other antiplatelet agents may be prescribed to alleviate coronary spasms and prevent clot formation. Close medical monitoring is crucial to ensure timely intervention and prevent complications.

On admission to the emergency department, I (Dr. A. Naga Srinivaas), along with Dr. Sambaji A S, Department of Cardiology, and Dr. Jyotsna Prashant, HDU Specialist, initiated the treatment. The patient was started on intravenous pheniramine maleate and hydrocortisone. However, there was deterioration in the condition post-treatment and his ECG taken at the time highlighted reduced blood flow to the heart. He rapidly developed palpitations, dizziness, and heaviness in the head, followed by severe chest pain with sweating. He was then managed with IV fluids and H2 receptor blockers.

His laboratory tests after 12 hrs including ECG and 2D-ECHO highlighted an acute coronary syndrome (heart attack or unstable angina) following coronary vasospasm due to the anaphylactic reaction. He was started on anti-platelet therapy immediately and was transferred to the high-dependency unit for further management. He was continued on dual anti-platelets, statin, and low molecular weight heparin and was closely monitored until his condition improved. 

The patient was moved back to the ward after the coronary angiogram came out normal. There was no further recurrence of the initial symptoms. He was discharged the following day with anti-platelets, statins, and antianginals with a close follow-up.

Consult our best interventional cardiologist in Bangalore if you need treatment for Kounis Syndrome. 


1. What are the key symptoms of Kounis syndrome?

The main symptoms of Kounis syndrome include the following:

  • Urticarial rashes & itching

  • Chest pain

  • Shortness of breath

  • Dizziness

  • Palpitations

2. Mention the risk factors for Kounis syndrome

The risk factors for Kounis syndrome include:

  • A history of allergies

  • Pre-existing coronary artery disease, including heart attack

  • Age (the condition is more prevalent among the older population)

  • Gender (Kounis Syndrome is more common in men)

3. How to prevent Kounis syndrome?

There’s no way to prevent this syndrome, but ensure the following to stay on the safer side:

  • Avoid contact with allergens. Keep your surroundings clean.

  • Take medication for known allergies. 

  • Avoid food that may cause allergic reactions to your body.

  • Don’t ignore rashes and itching in the body.

  • Get regular health checkups.

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