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Kounis NG, Mazarakis A, Bardousis C, Patsouras N. The heart and coronary arteries as primary target in severe allergic reactions: Cardiac troponins and the Kounis hypersensitivity-associated acute coronary syndrome. Int J Cardiol 2015; 198:83-4. [DOI: 10.1016/j.ijcard.2015.06.142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 06/27/2015] [Indexed: 02/02/2023]
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152
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Kounis NG, Cervellin G, Lippi G. Cisplatin-induced bradycardia: Cardiac toxicity or cardiac hypersensitivity and Kounis syndrome? Int J Cardiol 2015; 202:817-8. [PMID: 26476038 DOI: 10.1016/j.ijcard.2015.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 11/29/2022]
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153
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Cervellin G, Lippi G, Kounis NG. Letter by Cervellin et al Regarding Article, “Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction”. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.115.003166. [DOI: 10.1161/circinterventions.115.003166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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154
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Katsanou K, Karagiannidis I, Oikonomou G, Kounis NG. Kounis syndrome: Report of 3 cases. Int J Cardiol 2015; 197:222-3. [PMID: 26142966 DOI: 10.1016/j.ijcard.2015.06.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022]
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155
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Kounis NG. Scorpion bite, a sting to the heart and to coronaries resulting in Kounis syndrome. Indian J Crit Care Med 2015. [PMID: 26195871 PMCID: PMC4478686 DOI: 10.4103/0972-5229.158295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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156
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Kounis NG, Patsouras N, Grapsas N, Hahalis G. Histamine induced coronary artery spasm, fish consumption and Kounis syndrome. Int J Cardiol 2015; 193:39-41. [PMID: 26005172 DOI: 10.1016/j.ijcard.2015.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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157
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Kounis NG. Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome. Rev Port Cardiol 2015; 34:369-70. [PMID: 25935072 DOI: 10.1016/j.repc.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/02/2015] [Indexed: 10/23/2022] Open
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158
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Kounis NG, Kounis GN, Soufras GD, Tsigkas G, Hahalis G. Therapeutic hypothermia, stent thrombosis and the Kounis mast cell activation-associated syndrome. Int J Cardiol 2015; 179:504-6. [DOI: 10.1016/j.ijcard.2014.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 01/31/2023]
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159
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Kounis NG, Giannopoulos S, Soufras GD, Kounis GN, Goudevenos J. Foods, Drugs and Environmental Factors: Novel Kounis Syndrome Offenders. Intern Med 2015; 54:1577-82. [PMID: 26134186 DOI: 10.2169/internalmedicine.54.3684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kounis syndrome is hypersensitivity coronary disorder induced by various types of environmental exposures, drugs, conditions and stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. The disorder manifests as coronary spasms, acute myocardial infarction and stent thrombosis and affects the cerebral and mesenteric as well as coronary arteries. Importantly, its manifestations are broad and its etiology is continuously increasing. Recently, a variety of unusual etiologies have been reported including Anisakis simplex, scombroid syndrome, the use of Gelofusin or ultrasound contrast agents, kiwifruit, fly bites, and bee stings. Furthermore, losartan and the paradox of corticosteroid allergy have been implicated as possible causes. Although not rare, Kounis syndrome is infrequently diagnosed. Therefore, awareness of its etiology, manifestations and pathophysiology is important for providing the proper diagnosis and treatment and determining prognosis.
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Erol N, Karaagac AT, Kounis NG. Dangerous triplet: Polycystic ovary syndrome, oral contraceptives and Kounis syndrome. World J Cardiol 2014; 6:1285-1289. [PMID: 25548619 PMCID: PMC4278164 DOI: 10.4330/wjc.v6.i12.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/28/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome is characterized by ovulatory dysfunction, androgen excess and polycystic ovaries and is associated with hypertension, diabetes, metabolic syndrome and cardiovascular events. Oral contraceptives constitute first-line treatment, particularly when symptomatic hyperandrogenism is present. However, these drugs are associated with cardiovascular events and hypersensitivity reactions that pose problem in differential diagnosis and therapy. We present a 14 year-old female with polycystic ovary syndrome taking oral contraceptive and suffering from recurrent coronary ischemic attacks with increased eosinophils, and troponin levels suggesting Kounis syndrome.
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161
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Kounis NG, Kounis GN, Soufras GD. Therapeutic hypothermia associated with stent thrombosis: is Kounis mast cell activation-associated syndrome the culprit? Resuscitation 2014; 87:e3-4. [PMID: 25497392 DOI: 10.1016/j.resuscitation.2014.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/14/2022]
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162
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Kounis GN, Soufras GD, Tsigkas G, Kounis NG. Bioresorbable vascular scaffold subacute thrombosis and the Kounis syndrome. THE JOURNAL OF INVASIVE CARDIOLOGY 2014; 26:E170-E171. [PMID: 25481001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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163
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Kounis N, Soufras GD, Kounis GN, Kounis NG. eComment. Coronary artery aneurysm following stent implantation, hypersensitivity and Kounis syndrome. Interact Cardiovasc Thorac Surg 2014; 19:1070. [PMID: 25417224 DOI: 10.1093/icvts/ivu333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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164
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Kounis GN, Soufras GD, Kounis NG. Acute myocardial infarction and mortality in patients with systemic lupus erythematosus: the role of inflammatory cells and of Kounis syndrome. Int J Cardiol 2014; 177:142-3. [PMID: 25499361 DOI: 10.1016/j.ijcard.2014.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
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165
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Soufras GD, Hahalis G, Kounis NG. Thrombotic complications associated with transcatheter aortic valve implantation: the role of Kounis hypersensitivity-associated thrombotic syndrome. Cardiovasc Pathol 2014; 23:383-4. [DOI: 10.1016/j.carpath.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 11/30/2022] Open
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166
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Soufras GD, Tsigkas G, Hahalis G, Kounis NG. White blood count components as risk predictors for coronary heart disease: the role of eosinophils. Tex Heart Inst J 2014; 41:107. [PMID: 24512419 DOI: 10.14503/thij-13-4072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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167
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Mazarakis A, Bardousis K, Almpanis G, Mazaraki I, Ouzounis A, Kounis NG. Anaphylactic cardiovascular collapse during hemodialysis: Kounis syndrome in the dialysis room. World J Cardiol 2014; 6:1131-1134. [PMID: 25349659 PMCID: PMC4209441 DOI: 10.4330/wjc.v6.i10.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/12/2014] [Accepted: 08/31/2014] [Indexed: 02/06/2023] Open
Abstract
Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forces and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as myocardial infarction with cardiovascular collapse that occurred in the dialysis room following an allergic reaction. The dialysis apparatus material of polyurethane, polyamide, polycarbonate, silicon rubber and polypropylene were incriminated causes. Physicians should be aware of the causality and existence of this disorder in order to achieve early and correct diagnosis and apply the appropriate therapeutic measures.
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168
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Kounis NG, Davlouros P. Bleeding complication with dual antiplatelet therapy: spontaneous uvula hematoma. CMAJ 2014; 186:1168. [PMID: 25200759 DOI: 10.1503/cmaj.140270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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169
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. Bioabsorbable stent thrombosis Quo Vadis: Is Kounis syndrome still present? Int J Cardiol 2014; 176:305-6. [DOI: 10.1016/j.ijcard.2014.07.227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/27/2014] [Indexed: 12/01/2022]
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170
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Kounis NG, Soufras GD, Hahalis G. Anaphylactic cardiac collapse, sudden death and the Kounis syndrome. J Postgrad Med 2014; 60:227-9. [PMID: 25121360 DOI: 10.4103/0022-3859.138704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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171
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Kounis NG, Mazarakis A, Almpanis G, Gkouias K, Kounis GN, Tsigkas G. The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes. J Nat Sci Biol Med 2014; 5:240-4. [PMID: 25097390 PMCID: PMC4121890 DOI: 10.4103/0976-9668.136145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.
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172
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Soufras GD, Kounis NG, Hahali G. Corrigentum. Indian J Crit Care Med 2014. [DOI: 10.5005/ijccm-18-8-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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173
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Mazarakis A, Bardousis K, Almpanis G, Mazaraki I, Markou S, Kounis NG. Kounis syndrome following cold urticaria: the swimmer's death. Int J Cardiol 2014; 176:e52-3. [PMID: 25064198 DOI: 10.1016/j.ijcard.2014.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/05/2014] [Indexed: 11/16/2022]
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174
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Soufras GD, Kounis NG, Hahalis G, Hahali G. Unusual causes of anaphylaxis during surgery: Gelofusin-induced Kounis syndrome. Indian J Crit Care Med 2014; 18:410-1. [PMID: 24987250 PMCID: PMC4071695 DOI: 10.4103/0972-5229.133956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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175
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Kounis NG, Soufras GD, Hahalis G. Anaphylactic Shock: Kounis Hypersensitivity-Associated Syndrome Seems to be the Primary Cause. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:631-6. [PMID: 24404540 PMCID: PMC3877435 DOI: 10.4103/1947-2714.122304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.
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176
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. Device thrombosis with continuous-flow left ventricular assist devices: is Kounis syndrome involved? Artif Organs 2014; 38:521-3. [PMID: 24889668 DOI: 10.1111/aor.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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177
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Kounis NG, Kounis GN, Soufras GD. Amikacin, bupivacaine, fentanyl and Kounis syndrome. J Pharmacol Pharmacother 2014; 5:169-71. [PMID: 24799827 PMCID: PMC4008922 DOI: 10.4103/0976-500x.130152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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178
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González-de-Olano D, Gandolfo-Cano M, Mohedano-Vicente E, González-Mancebo E, Matito A, Kounis NG, Escribano L. Kounis syndrome following the performance of skin test to amoxicillin. Int J Cardiol 2014; 174:856-7. [PMID: 24801079 DOI: 10.1016/j.ijcard.2014.04.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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179
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost 2014; 21:139-43. [PMID: 24770327 DOI: 10.1177/1076029614531449] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count has emerged as a marker of inflammation that is widely available in clinical practice. Since inflammation plays a key role in atherosclerosis and its end results, discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy and provide prognostic information about coronary cardiac disease. In acute coronary syndromes and percutaneous coronary intervention, elevated levels of almost all subtypes of white blood cell counts, including eosinophils, monocytes, neutrophils, and lymphocytes, and neutrophil-lymphocyte ratio and eosinophil-leukocyte ratio constitute independent predictors of adverse outcomes. Eosinophil count and eosinophil-leukocyte ratio, in particular, emerge as novel biomarkers for risk stratification in patients with coronary artery disease. Since the presence of eosinophils denotes hypersensitivity inflammation and hypersensitivity associated with Kounis syndrome, this reality is essential for elucidating the etiology of inflammation in order to consider predictive and preventive measures and to apply the appropriate therapeutic methods.
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Soufras GD, Kounis NG. Patent foramen ovale, transient ischemic attack and Kounis syndrome. Int J Cardiol 2014; 172:e303. [PMID: 24461972 DOI: 10.1016/j.ijcard.2013.12.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/28/2013] [Indexed: 11/16/2022]
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181
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. Adverse cardiac events to monoclonal antibodies used for cancer therapy: The risk of Kounis syndrome. Oncoimmunology 2014; 3:e27987. [PMID: 25340003 PMCID: PMC4203633 DOI: 10.4161/onci.27987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 01/24/2014] [Indexed: 01/13/2023] Open
Abstract
Monoclonal antibodies are currently used in the treatment of neoplastic, hematological, or inflammatory diseases, a practice that is occasionally associated with a variety of systemic and cutaneous adverse events. Cardiac adverse events include cardiomyopathy, ventricular dysfunction, arrhythmias, arrests, and acute coronary syndromes, such as acute myocardial infarction and vasospastic angina pectoris. These events generally follow hypersensitivity reactions including cutaneous erythema, pruritus chills, and precordial pain. Recently, IgE specific for therapeutic monoclonal antibodies have been detected, pointing to the existence of hypersensitivity and Kounis hypersensitivity-associated syndrome. Therefore, the careful monitoring of cardiovascular events is of paramount importance in the course of monoclonal antibody-based therapies. Moreover, further studies are needed to elucidate the pathophysiology of cardiovascular adverse events elicited by monoclonal antibodies and to identify preventive, protective, and therapeutic measures.
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182
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Kounis NG, Soufras GD, Hahalis G. Stent hypersensitivity and infection in sinus cavities. ALLERGY & RHINOLOGY 2014; 4:e162-5. [PMID: 24498522 PMCID: PMC3911806 DOI: 10.2500/ar.2013.4.0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed.
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183
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Kounis NG, Kounis GN, Kouni SN, Soufras GD. Allergy to Heparins, Thrombosis, Thrombocytopaenia and Kounis Syndrome: A Clinical Paradox. Heart Lung Circ 2014; 23:103-4. [DOI: 10.1016/j.hlc.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/10/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
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184
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Soufras GD, Hahali G, Kounis NG, Kounis NG. Relation between white blood cell count and infarct size: what about differential? Am J Cardiol 2014; 113:412. [PMID: 24387903 DOI: 10.1016/j.amjcard.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 10/24/2013] [Indexed: 12/01/2022]
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185
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood count and infarct size, myocardial salvage and clinical outcomes: the role of differentials. Int J Cardiovasc Imaging 2014; 30:677-9. [PMID: 24384860 DOI: 10.1007/s10554-013-0359-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
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186
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Kounis NG, Kounis GN, Soufras GD, Tsigkas G, Hahalis G. Attention to Infliximab adverse events: chimeric monoclonal antibodies can induce anti chimeric antibodies that may result in Kounis hypersensitivity associated acute coronary syndrome. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2014; 18:3735-3736. [PMID: 25555859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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187
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. Are bioabsorbable and biodegradable polymer scaffolds still safe or Kounis syndrome is still watching for? Chin Med J (Engl) 2014; 127:4159. [PMID: 25430471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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188
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Kounis NG, Soufras GD. Coronary stent thrombosis: beware of an allergic reaction and of Kounis syndrome. Indian Heart J 2013; 66:153-5. [PMID: 24814107 DOI: 10.1016/j.ihj.2013.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/04/2013] [Indexed: 12/11/2022] Open
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189
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Soufras GD, Kounis GN, Kounis NG. Fatal anaphylactic reaction to iron sucrose in pregnancy: iron-induced Kounis syndrome? Indian J Pharmacol 2013; 45:642-3. [PMID: 24347784 PMCID: PMC3847266 DOI: 10.4103/0253-7613.121393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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190
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Kounis NG. Kounis syndrome: a monster for the atopic patient. Cardiovasc Diagn Ther 2013; 3:1-4. [PMID: 24282739 DOI: 10.3978/j.issn.2223-3652.2013.02.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/20/2013] [Indexed: 01/12/2023]
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191
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Mazarakis A, Goudevenos J, Kounis NG. Coronary vasospasm induced by cytostatic drugs: Kounis syndrome seems to be the most likely culprit. Hellenic J Cardiol 2013; 54:482-485. [PMID: 24305588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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192
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Kounis NG, Soufras GD, Hahalis G. Accumulation of eosinophils, mast cells, and basophils in the spleen and the coronary arteries in anaphylactic deaths: is the Kounis hypersensitivity associated syndrome present? Forensic Sci Med Pathol 2013; 10:150-1. [DOI: 10.1007/s12024-013-9489-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
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193
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Cheng TO, Kounis NG. Corrigendum to “Takotsubo cardiomyopathy, mental stress and the Kounis syndrome” [Int J Cardiol 161 (2) (2012) 65–67]. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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194
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Kounis NG, Soufras GD, Kounis GN. Safety of using anti-TNF-α blockers in cardiac failure associated with systemic inflammatory disease and the risk of Kounis syndrome. Int J Cardiol 2013; 168:540-1. [DOI: 10.1016/j.ijcard.2013.01.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/13/2013] [Indexed: 10/27/2022]
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195
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Mazaraki I, Gkouias K, Almpanis G, Kounis NG, Mazarakis A. Carbamate skin contact-induced atrial fibrillation: Toxicity or hypersensitivity? Int J Cardiol 2013; 168:e11-2. [DOI: 10.1016/j.ijcard.2013.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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196
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Soufras GD, Kounis GN, Kounis NG. Brain injury due to anaphylactic shock: broadening manifestations of Kounis syndrome. Int Endod J 2013; 47:309-13. [PMID: 23889503 DOI: 10.1111/iej.12152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/13/2013] [Indexed: 11/26/2022]
Abstract
Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management.
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197
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Kounis NG, Soufras GD, Kounis GN. Antibodies against antibodies inducing Kounis syndrome. Int J Cardiol 2013; 168:4804-5. [PMID: 23880582 DOI: 10.1016/j.ijcard.2013.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022]
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198
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Kounis NG. Eosinophils and Kounis hypersensitivity associated syndrome as contributors to very late coronary stent thrombosis. Int J Cardiol 2013; 167:594-5. [DOI: 10.1016/j.ijcard.2012.09.221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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199
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Kounis NG. Caspofungin-induced fatal complete heart block: Another manifestation of Kounis syndrome. J Pharmacol Pharmacother 2013; 4:161-2. [PMID: 23761719 PMCID: PMC3669582 DOI: 10.4103/0976-500x.110918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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200
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Kounis NG, Soufras GD. Nerve, muscle and heart acute toxicity following oxaliplatin and capecitabine treatment. Neuromuscul Disord 2013; 23:524-5. [DOI: 10.1016/j.nmd.2013.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
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