Key result
Adrenaline triggers ACS and aspirin worsens anaphylaxis in Kounis syndrome case report.
Why the study?
Aspirin and adrenaline are guideline-recommended treatments for ACS and anaphylaxis, but both can worsen clinical outcomes in concurrent ACS and anaphylaxis (Kounis syndrome).
Case Report (n=1)
In patients with Kounis syndrome (concurrent ACS and anaphylaxis), standard guideline-recommended treatments like adrenaline and aspirin may cause clinical worsening, highlighting the need for tailored therapies such as clopidogrel and glucagon.
Urges caution with adrenaline and aspirin in suspected Kounis syndrome; leaves open optimal management strategies for this rare overlap.
BACKGROUND: Although aspirin and adrenaline are the guideline-recommended treatments for acute coronary syndrome (ACS) and anaphylaxis, both regimens can contribute to clinical worsening in the setting of concurrent ACS and anaphylaxis which is called allergic angina or Kounis syndrome. CASE SUMMARY: A 62-year-old woman with food-dependent exercise-induced anaphylaxis developed ACS after intramuscular injection of adrenaline for the treatment of anaphylaxis, whereas administered aspirin for the treatment of ACS exacerbated anaphylaxis. DISCUSSION: Our case underlines the importance of tailored treatment based on the underlying pathophysiology of individual patients. Clopidogrel and glucagon might be a better alternative for the treatment of Kounis syndrome.
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Toya et al. (2019) conducted a case report in Food-dependent exercise-induced anaphylaxis and acute coronary syndrome (Kounis syndrome) (n=1). Adrenaline and aspirin was evaluated on Clinical worsening (ACS development and anaphylaxis exacerbation). Administration of adrenaline for anaphylaxis induced acute coronary syndrome, and subsequent aspirin treatment exacerbated anaphylaxis in a 62-year-old woman with Kounis syndrome.
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