Kounis syndrome in a patient with secondary mast cell activation syndrome after a bee sting
Kounis syndrome in a patient with secondary mast cell activation syndrome after a bee sting
A 64-year-old male patient was admitted to our clinic with complaints of hot flashes all over the body, fainting and loss of consciousness after a bee sting. The patient who had no history of coronary artery disease was fitted with a stent in the LADcoronary artery with a percutaneous coronary angioplasty by complaints of chest pain and shortness of breath after the bee sting. I3 Vespula spp (yellow jacket) in serum was positive at 0.39 kUA / L-class 1. Tryptase levels were elevated at 19.5/g/L during the asymptomatic period. After the tryptase levels remained elevated at 49.2/g/L during the asymptomatic period after 4 weeks. Thebone marrow biopsy revealed a mast cell ratio of 2%. Based on the patient’s history, physical examination and laboratory findings, the patient was considered to have Kounis syndrome, mast cell activation syndrome and a venom allergy.
___
- 1. Akin C, Valent P, Metcalfe DD. Mast cell activation syndrome: Proposed diagnostic criteria. J Allergy Clin Immunol Pract 2010;126:1099-104.
- 2. Valent P, Akin C, Arock M, et al. Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: A consensus proposal. Int Arch Allergy Immunol 2012;157:215-25.
- 3. Valent P. Mast cell activation syndromes: definition and classification. Allergy 2013;68:417-24.
- 4. Bongo AS, Fornaro G, Sansa M, et al. [Acute myocardial infarction after wasp sting without anaphylactic reaction]. Italian heart journal Supplement : Official J the Italian Federation of Cardiology 2005;6:178-82.
- 5. Metcalfe DD. Mast cells and mastocytosis. Blood 2008;112:946-56.
- 6. Rivera J, Gilfillan AM. Molecular regulation of mast cell activation. J Allergy Clin Immunol Pract 2006;117:1214-25.
- 7. Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2006;97:39-43.
- 8. Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm? Int J Cardiol 2006;110:7-14.
- 9. Biteker M, Duran N, Biteker F, et al. Kounis syndrome: First series in Turkish patients. Anadolu kardiyoloji dergisi : Akd = The Anatolian J Cardiology 2009;9:59- 60.
- 10. Kartal Ö, Güleç M, Çalışkaner AZ, Kounis Syndrome: Allergic Angina and Allergic Myocardial Infarction: Review. Türkiye Klinikleri Cardiovascular Sciences 2010;22:253-61.
- 11. Aminiahidashti H, Laali A, Samakoosh AK, et al. Myocardial infarction following a bee sting: A case report of Kounis syndrome. Annals of Cardiac Anaesthesia 2016;19:375-8.
- 12. Niedoszytko M, Bonadonna P, Oude Elberink JN. Epidemiology, diagnosis, and treatment of Hymenoptera venom allergy in mastocytosis patients. Immunology and Allergy Clinics of North America 2014;34:365-81.
- 13. Brockow K, Jofer C, Behrendt H, et al.Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy 2008;63:226-32.
- 14. Bonadonna P, Perbellini O, Passalacqua G, et al. Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels. J Allergy Clin Immunol Pract 2009;123:680-6.
- 15. Guenova E, Volz T, Eichner M, et al. Basal serum tryptase as risk assessment for severe Hymenoptera sting reactions in elderly. Allergy 2010;65:919-23.
- 16. Yilmaz I, Bahcecioglu SN, Turk M. Combination of omalizumab and bee venom immunotherapy: does it work? Asia Pacific allergy 2018;8:2.
- 17. Castells MC, Hornick JL, Akin C. Anaphylaxis after hymenoptera sting: is it venom allergy, a clonal disorder, or both? J Allergy Clin Immunol Pract 2015;3:350-5.
- 18. da Silva EN, Randall KL. Omalizumab mitigates anaphylaxis during ultrarush honey bee venom immunotherapy in monoclonal mast cell activation syndrome. J Allergy Clin Immunol Pract 2013;1:687-8.
- 19. Kontou-Fili K. High omalizumab dose controls recurrent reactions to venom immunotherapy in indolent systemic mastocytosis. Allergy 2008;63:376- 8.
- 20. Galera C, Soohun N, Zankar N, et al. Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. Journal Of Investigational Allergology & Clinical Immunology. 2009;19:225-9.
- 21. Welzel T, Ziesenitz VC, Seitz S, et al. Management of anaphylaxis and allergies in patients with long QT syndrome: A review of the current evidence. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2018;121:545-51.
- 22. Javeed N, Javeed H, Javeed S, et al. Refractory anaphylactoid shock potentiated by beta-blockers. Catheterization and Cardiovascular Diagnosis 1996;39:383-4.
- 23. Zaloga GP, DeLacey W, Holmboe E, et al. Glucagon reversal of hypotension in a case of anaphylactoid shock. Annals of Internal Med 1986;105:65-6.