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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Esta revisión aborda el síndrome de Kounis, en el cual la degranulación de mastocitos y los mediadores inflamatorios durante reacciones alérgicas o anafilácticas pueden provocar episodios de isquemia aguda, espasmo coronario, erosión o rotura de placa y activación plaquetaria. El resumen enumera explícitamente la hirudoterapia entre varios medicamentos y sustancias utilizados para tratar el infarto de miocardio y el síndrome de Kounis —tales como adrenalina, aspirina, atropina, clopidogrel, corticosteroides, heparinas y sulfato de protamina— que también pueden desencadenar el síndrome. Esto es relevante para el ámbito de ASH como consideración de seguridad para la hirudoterapia. Sin embargo, el artículo es una revisión, la hirudoterapia se menciona únicamente como un elemento dentro de una lista, y el resumen no aporta incidencia, detalles de casos ni cuantificación del riesgo asociado a la hirudoterapia.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026