Allergic Acute Coronary Syndrome; A Fatal Presentation in the Emergency Department


Allergic angina is not a rare disease, but it should be recognized at the earliest. We are reporting two cases of anaphylaxis, one with a history of unknown insect bite and the other due to intravenous (IV) contrast, leading to reversible myocardial ischemia, which we managed in our Emergency Department. These two patients clinically improved, and their ST-segment elevation on electrocardiogram (ECG) disappeared after intramuscular adrenaline. Allergic angina is an acute presentation in which anaphylaxis, or allergic insult, causes coronary spasm, which leads to angina. Early diagnosis and management initiation can minimize mortality and morbidity.

1. Tsigkas G, Chouchoulis K, Kounis NG, Alexopoulos D. Allergic reaction reveals a non-lethal late stent thrombosis. A new subtype of Kounis syndrome? Int J Cardiol. 2011;149(2):281-182.
2. Helbling A, Hurni T, Mueller UR, Pichler WJ. Incidence of anaphylaxis with circulatory symptoms: A study over a 3-year period comprising 940 000 inhabitants of the Swiss Canton Bern. Clin Exp Allergy. 2004;34(2):285-90.
3. Kounis NG. Coronary hypersensitivity disorder: The Kounis syndrome. Clin Ther. 2013;35(5):563-71.
4. Lippi G, Buonocore R, Schirosa F, Cervellin G. Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions. A case-control study. Int J Cardiol. 2015;194:68-9.
IssueVol 5 No 2 (2021): Spring (April) QRcode
SectionCase based learning points
DOI 10.18502/fem.v5i2.5629
Acute Coronary Syndrome Anaphylaxis Hypersensitivity Kounis Syndrome

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Duvvada G, Swaminathane R, Suresh Kumar TS. Allergic Acute Coronary Syndrome; A Fatal Presentation in the Emergency Department. Front Emerg Med. 2021;5(2):e25.


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