Kounis Syndrome Features in Special Populations.

ingentiumby ingentium

In Clinical Literature.

Publication date: Apr 28, 2026

Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies.

Open Access PDF

Concepts Keywords
Asthmatics allergy
Cardiac anaphylactic reactions
Host Female
Immunologic Humans
Underestimated hypersensitivity
Kounis Syndrome
Kounis syndrome
Pregnancy
special populations

Semantics

Type Source Name
disease MESH Kounis Syndrome
disease MESH acute coronary syndromes
disease MESH hypersensitivity
disease MESH anaphylactic reactions
disease MESH cardiovascular disease
disease MESH food allergies
disease MESH insect stings
disease MESH chronic kidney disease
disease MESH inflammation
disease MESH COVID-19
pathway REACTOME Metabolism
drug DRUGBANK Coenzyme M
disease MESH dys
disease MESH foreign body
drug DRUGBANK L-Phenylalanine
disease MESH carditis
disease MESH serum sickness
disease MESH urticaria
disease MESH coronary vasospasm
disease MESH rupture
disease MESH myocardial infarction
disease MESH syndrome
disease MESH emergency
disease MESH spasm
disease MESH thrombosis
disease MESH included
pathway REACTOME Immune System
drug DRUGBANK Histamine
drug DRUGBANK Platelet Activating Factor
disease MESH coronary artery disease
drug DRUGBANK Chromium
drug DRUGBANK Cobalt
disease MESH hypotension
disease MESH syncope
disease MESH heart failure
disease MESH cardiogenic shock
drug DRUGBANK Diphenylpyraline
disease MESH MINOCA
disease MESH microvascular angina
disease MESH myocardial ischemia
drug DRUGBANK Metronidazole
drug DRUGBANK Mesalazine
drug DRUGBANK Atropine
drug DRUGBANK Rocuronium
drug DRUGBANK Isoflurane
disease MESH bites
disease MESH chest pain
drug DRUGBANK Sulodexide
drug DRUGBANK Titanium
drug DRUGBANK Isoxaflutole
drug DRUGBANK Nitrate
drug DRUGBANK Nitric Oxide
disease MESH Uremia
disease MESH injury
disease MESH infarction
drug DRUGBANK Heparin
disease MESH pain
disease MESH left ventricular hypertrophy
disease MESH vascular calcification
disease MESH bleeding
drug DRUGBANK Epinephrine
disease MESH recurrence
disease MESH coronary disease
disease MESH atherosclerosis
drug DRUGBANK Methylergometrine
disease MESH fetal hypoxia
drug DRUGBANK Oxytocin
drug DRUGBANK Ondansetron
disease MESH asthma
pathway KEGG Asthma
disease MESH atherosclerotic plaques
pathway REACTOME Smooth Muscle Contraction
disease MESH drug hypersensitivities
drug DRUGBANK Omalizumab
drug DRUGBANK Dupilumab
disease MESH Severe acute respiratory syndrome
drug DRUGBANK Angiotensin II
disease MESH infection
pathway KEGG Platelet activation
disease MESH convalescence
disease MESH vascular remodeling
drug DRUGBANK Hexachlorophene
disease MESH edema
drug DRUGBANK Fenamole
disease MESH ischemia
disease MESH pneumonia
disease MESH Chronic spontaneous urticaria
drug DRUGBANK Acetylsalicylic acid
disease MESH rhinosinusitis
disease MESH nasal polyps
disease MESH systemic lupus erythematosus
pathway KEGG Systemic lupus erythematosus
disease MESH arthritis
disease MESH vasculitides
disease MESH autoimmune diseases
disease MESH ers
disease MESH tumor
drug DRUGBANK Epirubicin
drug DRUGBANK Cisplatin
drug DRUGBANK Cyclophosphamide
disease MESH diabetes mellitus
disease MESH dyslipidemia
disease MESH vascular injury
drug DRUGBANK Rituximab
drug DRUGBANK Bevacizumab
drug DRUGBANK Ramucirumab
drug DRUGBANK Trastuzumab
drug DRUGBANK Pertuzumab
drug DRUGBANK Alemtuzumab
drug DRUGBANK Aflibercept
disease MESH erythema
disease MESH pruritus
disease MESH chills
drug DRUGBANK Fluorouracil
drug DRUGBANK Capecitabine
drug DRUGBANK Platinum
disease MESH coronary thrombosis
drug DRUGBANK Paclitaxel
drug DRUGBANK Docetaxel
drug DRUGBANK Vincristine
drug DRUGBANK Vinblastine
drug DRUGBANK Nilotinib
drug DRUGBANK Ponatinib
drug DRUGBANK Sunitinib
drug DRUGBANK Sorafenib
drug DRUGBANK Pazopanib
drug DRUGBANK Ipilimumab
drug DRUGBANK Nivolumab
drug DRUGBANK Pembrolizumab
disease MESH pericarditis
drug DRUGBANK Trestolone
disease MESH dis
disease MESH neurodevelopmental disorders
disease MESH anxiety
disease MESH mood disorders
disease MESH bipolar disorder
disease MESH autism
disease MESH neuroinflammation
disease MESH cognitive impairment
disease MESH neurological disorders
disease MESH systemic mastocytosis
disease MESH psychiatric disorders
disease MESH headache
disease MESH dysautonomia
disease MESH generalized anxiety disorder
disease MESH genetic predisposition
disease MESH clinical progression
disease MESH ST elevation myocardial infarction
disease MESH hypertension
disease MESH stroke
disease MESH cardiac arrest
disease MESH chronically ill
disease MESH clinical deterioration
drug DRUGBANK Gold
drug DRUGBANK Sirolimus
drug DRUGBANK Sennosides
disease MESH Cardiorenal syndrome
disease MESH Hematoma
disease MESH Arterial Dissection
disease MESH Shock
disease MESH latex allergy
pathway REACTOME Leukotriene receptors
disease MESH Vascular Diseases
drug DRUGBANK Guanosine
disease MESH Long COVID
disease MESH Streptococcus pneumoniae Infection
drug DRUGBANK Moxifloxacin
disease MESH Cardiac Diseases
disease MESH cardiac arrhythmias
disease MESH Ash
drug DRUGBANK (S)-Des-Me-Ampa
disease MESH Metabolic Syndrome
disease MESH Psoriasis
disease MESH cardiomyopathy
drug DRUGBANK Oxymetazoline

Original Article

(Visited 6 times, 1 visits today)

Leave a Comment

Your email address will not be published. Required fields are marked *