FIGURE 1.
Electrocardiogram on presentation showing QS wave in V1–V3, ST elevation of 4 mm in leads V3–V4, 1–2 mm in leads V2, V5–V6, and 0.5 mm in leads DI and aVL.
FIGURE 2.
Pathophysiological link between chronic spontaneous urticaria and Kounis syndrome type I.
TABLE 1.
Kounis syndrome associated with idiopathic anaphylaxis
| Sandhu et al., 2017 | Keber et al., 2017 | |
|---|---|---|
| Country | USA | Slovenia |
| Patient profile | 65, female, with a history of malignant idiopathic anaphylaxis | 48, male |
| Trigger | Idiopathic anaphylaxis | Idiopathic anaphylaxis |
| Allergic symptoms | Present (facial flushing) | Present (skin changes, dyspnea) |
| Presentation | Chest pain | Chest pain, dyspnea, nausea |
| Coronary artery disease | No, confirmed by computed tomography angiography | No, confirmed by coronary angiography |
| Biomarkers | Troponin rise | Troponin rise, elevated tryptase during attacks |
| Electrocardiogram | NSTEMI | STEMI |
| Therapeutic management | Loratadine, famotidine, corticosteroids | Antihistamines |
TABLE 2.
Kounis syndrome associated with chronic spontaneous urticaria
| Erxun et al., 2016 | Brancaccio et al., 2024 | |
|---|---|---|
| Country | China | Italy |
| Patient profile | 31, female, chronic autoimmune urticaria | 47, female, chronic spontaneous urticaria |
| Trigger | No apparent trigger | No apparent trigger |
| Allergic symptoms | Erythema and wheals on trunk and limbs | Edema and wheals on lips and eyelids |
| Presentation | Chest pain, diaphoresis, palpitations | Chest pain |
| Coronary artery disease | No, confirmed by coronary angiography | No, confirmed by coronary angiography |
| Biomarkers | Troponin rise, serum anti-high affinity IgE receptor antibody test positive | Troponin rise, elevated tryptase during attacks |
| Electrocardiogram | STEMI | STEMI |
| Therapeutic management | Cetirizine, methylprednisolone and then prednisone, azathioprine | Cetirizine, prednisone, omalizumab |