Tzanis G, Bonou M, Mikos N, Biliou S, Koniari I, Kounis NG, Barbetseas J. Early stent thrombosis secondary to food allergic reaction: Kounis syndrome following rice pudding ingestion. World J Cardiol 2017; 9(3): 283-288 [PMID: 28400926 DOI: 10.4330/wjc.v9.i3.283]
Corresponding Author of This Article
Nicholas G Kounis, MD, PhD, FESC, FACC, FAHA, Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, 26221 Patras, Greece. ngkounis@otenet.gr
Research Domain of This Article
Allergy
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Mar 26, 2017; 9(3): 283-288 Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.283
Early stent thrombosis secondary to food allergic reaction: Kounis syndrome following rice pudding ingestion
Georgios Tzanis, Maria Bonou, Nikolaos Mikos, Smaragda Biliou, Ioanna Koniari, Nicholas G Kounis, John Barbetseas
Georgios Tzanis, Maria Bonou, Smaragda Biliou, John Barbetseas, Department of Cardiology, “Laiko” General Hospital, 11527 Athens, Greece
Nikolaos Mikos, Department of Allergology and Clinical Immunology, “Laiko” General Hospital, 11527 Athens, Greece
Ioanna Koniari, Nicholas G Kounis, Department of Cardiology, University of Patras Medical School, Rion, 26221 Patras, Achaia, Greece
Author contributions: Tzanis G contributed to acquisition of data, reviewed the literature and drafted the manuscript; Bonou M and Biliou S contributed to acquisition of data, reviewed the literature and helped to draft the manuscript; Koniari I reviewed the literature, and helped to draft the manuscript; Mikos N performed the allergology tests; Barbetseas J critically revised the manuscript; Kounis NG critically revised the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This case report conforms to the ethical standards of our institution.
Informed consent statement: The patient involved in this study gave his verbal informed consent authorizing use of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicholas G Kounis, MD, PhD, FESC, FACC, FAHA, Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, 26221 Patras, Greece. ngkounis@otenet.gr
Telephone: +30-26-10279579 Fax: +30-26-10279579
Received: October 1, 2016 Peer-review started: October 11, 2016 First decision: November 10, 2016 Revised: November 22, 2016 Accepted: January 11, 2017 Article in press: January 14, 2017 Published online: March 26, 2017 Processing time: 176 Days and 15 Hours
Abstract
Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.
Core tip: Kounis syndrome highlights, the role of anaphylactic mediated acute coronary syndromes complicating stent thrombosis in the era of invasive treatment of coronary artery disease. Drugs, stings, bites, contrast material, atopic diathesis and even food ingestion could be the culprits. Managing the complex pathophysiology of this condition is a challenging issue, especially in the emergency setting, that requires rapid treatment decisions. The role of detailed past history and of preventive anti-allergic medication in high risk patients with anaphylactic reactions should be considered in randomized studies.
