Allergy-Associated Acute Coronary Syndromes

BACKGROUND: Kounis syndrome (KS) is a rare but clinically significant manifestation of acute coronary syndrome triggered by allergic, anaphylactic, or anaphylactoid reactions. Despite its potential severity, KS remains under-recognized in clinical practice. OBJECTIVE: To present a case series illustrating the 3 subtypes of KS and to propose a management algorithm tailored to its unique pathophysiology. METHODS: We describe 3 patients, each representing one of the KS subtypes: type 1 (coronary spasm without underlying disease), type 2 (plaque rupture in pre-existing coronary disease), and type 3 (stent thrombosis). All cases were managed in collaboration with cardiologists at the Victorian Heart Hospital, Monash Health. CONCLUSIONS: KS requires a distinct diagnostic and therapeutic approach compared to classic acute coronary syndrome. Our proposed algorithm aims to guide clinicians in recognizing and managing this complex syndrome effectively.