Allergy-Associated Acute Coronary Syndromes: A Case Series and Therapeutic Framework for Kounis Syndrome.

Abstract

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(s): To present a case series illustrating the 3 subtypes of KS and to propose a management algorithm tailored to its unique pathophysiology. Method(s): 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. Conclusion(s): 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.Copyright © 2026 The Authors