Review Article| Volume 30, P7-10, May 2016

Kounis syndrome: A concise review with focus on management

Published:January 12, 2016DOI:


      • Kounis syndrome pathogenesis and epidemiology have been described.
      • Treatment of Kounis syndrome has been discussed.
      • A treatment flow-chart has been proposed.
      • This narrative review has been conducted analyzing the scientific literature.
      • More recent scientific evidence have been highlighted into this review.


      Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event and was first described by Kounis and Zavras in 1991 as an allergic angina syndrome.
      Multiple causes have been described and most of the data in the literature are derived from the description of clinical cases – mostly in adult patients – and the pathophysiology remains only partly explained.
      Three different variants of Kounis syndrome have been defined: type I (without coronary disease) is defined as chest pain during an acute allergic reaction in patients without risk factors or coronary lesions in which the allergic event induces coronary spasm that electrocardiographic changes secondary to ischemia; type II (with coronary disease) includes patients with pre-existing atheromatous disease, either previously quiescent or symptomatic, in whom acute hypersensitive reactions cause plaque erosion or rupture, culminating in acute myocardial infarction; more recently a type-III variant of Kounis syndrome has been defined in patients with preexisting coronary disease and drug eluting coronary stent thrombosis.
      The pathogenesis of the syndrome is discussed, and a therapeutic algorithm is proposed.


      KS (Kounis syndrome), ACS (Acute coronary syndrome)


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      Linked Article

      • Author's reply: Kounis syndrome: Aspects on pathophysiology and management
        European Journal of Internal MedicineVol. 32
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          We thank Kounis and coll. for their Letter to the Editor [1] commenting and congratulating for our recently published article “Kounis syndrome: A concise review with focus on management” [2].
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      • Kounis syndrome: Aspects on pathophysiology and management
        European Journal of Internal MedicineVol. 32
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          We read with the great interest the excellent and concise review of Filippo Fassio et al. [1] focused on Kounis syndrome and its treatment. Since the description of this syndrome has paved the possibility for prevention of the progression of coronary plaques to unstable lesions with inhibition of mast cell activation, that has been already achieved experimentally [2], we believe that the following observations and additions on its pathophysiology and management would be of value.
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