Allergic angina syndrome, allergic myocardial infarct or Kounis syndrome: insights on epidemiology, etiology, diagnosis and treatment. A case report by gadolinium anaphylaxis

Enrico Macías, Departamento de Cardiología, Hospital Ángeles del Pedregal, Ciudad de México, México
Eduardo Amador, Departamento de Cardiología, Hospital Ángeles del Pedregal, Ciudad de México, México
Argentina Sandia, Departamento de Terapia Intensiva, Hospital Ángeles del Pedregal, Ciudad de México, México
Santiago Taracena, Departamento de Medicina Interna. Hospital Ángeles del Pedregal, Ciudad de México, México

Kounis syndrome (KS) was first described in 1991 by Kounis and Zavras and is also known as allergic angina syndrome or allergy myocardial infarction. It is a rare, and frequently undiagnosed syndrome that is characterized by an anaphylactic reaction. Allergens cause massive degranulation of mast cells leading to coronary spasm, microvascular angina, and/or endothelial dysfunction with myocardial infarction. The annual incidence of severe, life-threatening anaphylaxis with circulatory symptoms is about 7.9-9.6 cases per 100,000 people. More than 300 cases of KS have been described after exposure to various agents such as drugs, insect venoms, food, or medicated stents. Although the incidence of KS is very low, the incidence of myocardial infarction due to anaphylaxis secondary to gadolinium is even lower, reported in a range of 0.002-0.01%. The objective of this article is to review the current data on KS, regarding a case of allergy to gadolinium, which has an extremely low incidence.

Keywords: Allergy. Angina. Myocardial infarction. Kounis syndrome. Gadolinium.