Unusual, Uncommon, Intriguing, and Significant Causes of Kounis Syndrome: Important Medications and Chemicals Used to Treat Kounis Syndrome and Myocardial Infarction Can Cause Kounis Syndrome
Review published in J Cardiovasc Dev Dis (2025)
Abstract
Mast cell degranulation and other interacting and linked cells, including T-lymphocytes, macrophages, eosinophils, and platelets, as well as a range of inflammatory mediators produced during an anaphylactic or allergic reaction, constitute the main causes of Kounis syndrome. Acute ischemia episodes, coronary spasm, atheromatous plaque erosion/rupture, and platelet activation can all be caused by histamine, tryptase, arachidonic acid derivatives, and chymase in the Kounis syndrome cascade. Kounis syndrome can be triggered by a variety of factors, including medications, hymenopteran stings, metals, foods, environmental exposures, illnesses, and immunizations. In addition, some unusual, rare, intriguing, and significant causes of Kounis syndrome have been discovered recently, namely the "kiss of death", where human kissing and pet kissing can induce fatal Kounis syndrome. Moreover, the clinical conundrum is that several of the main drugs and substances used to treat myocardial infarction and Kounis syndrome, such as adrenaline (epinephrine), aspirin, atropine, clopidogrel, corticosteroids, heparins, protamine sulfate, and hirudotherapy can also initiate it. Therefore, physicians should be aware of this clinical discrepancy to prevent catastrophic consequences.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Mast cell degranulation and other interacting and linked cells, including T-lymphocytes, macrophages, eosinophils, and platelets, as well as a range of inflammatory mediators produced during an anaphylactic or allergic reaction, constitute the main causes of Kounis syndrome.
Why This Matters for Hirudotherapy
This review discusses Kounis syndrome, in which mast cell degranulation and inflammatory mediators during allergic or anaphylactic reactions can cause acute ischemia episodes, coronary spasm, plaque erosion or rupture, and platelet activation. The abstract explicitly lists hirudotherapy among several medications and substances used to treat myocardial infarction and Kounis syndrome—such as adrenaline, aspirin, atropine, clopidogrel, corticosteroids, heparins, and protamine sulfate—that can also initiate the syndrome. This is relevant to ASH's domain as a safety consideration for hirudotherapy. However, the article is a review, hirudotherapy is mentioned only as one item in a list, and the abstract provides no incidence, case details, or quantification of hirudotherapy-associated risk.
Citation
Unusual, Uncommon, Intriguing, and Significant Causes of Kounis Syndrome: Important Medications and Chemicals Used to Treat Kounis Syndrome and Myocardial Infarction Can Cause Kounis Syndrome.
Kounis NG et al. · J Cardiovasc Dev Dis, 2025
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