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<p>Kounis syndrome is an acute coronary syndrome (ACS) triggered by allergic reactions via mast cell activation, classically accompanied by anaphylaxis. However, ACS associated with mild or subclinical allergic reactions may be underrecognized. We investigated immune markers and autonomic nervous system activity in patients with ACS and characterized allergy-associated ACS without anaphylactic symptoms. Among 375 patients treated for ACS (April 2022 to March 2024), 49 were prospectively enrolled. Patients were classified into non-allergy-associated ACS (ACS-NA, n = 32) and allergy-associated ACS (ACS-AL, n = 17) groups. ACS-AL was subdivided into the non-anaphylactic (ACS-AL(nonA), n = 11) and anaphylactic (ACS-AL(withA), n = 6) groups. Allergic status was comprehensively assessed. Serum IgE and plasma histamine were measured at ACS onset. Heart rate variability (HRV) parameters were analyzed using 24-h ambulatory monitoring within 1&#xa0;week after percutaneous coronary intervention. The ACS-AL(nonA) and ACS-AL(withA) groups showed significantly higher IgE and histamine levels than the ACS-NA group (P &lt; 0.05), with overlapping distributions. HRV analysis revealed elevated LF/HF ratios and reduced daytime HF in both groups, indicating sympathetic predominance. ACS-AL, even without anaphylaxis, involves immune activation and autonomic imbalance. Combined assessment of IgE, histamine, and HRV may improve the identification of this phenotype.</p>

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Allergy-associated acute coronary syndrome without anaphylaxis in a prospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月7日

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  • Mari Amino,
  • Shie Takizawa,
  • Seiji Morita,
  • Kanae Kitatani,
  • Ayumi Sasaki,
  • Atsuhiko Yagishita,
  • Yoshihide Nakagawa,
  • Yuji Ikari,
  • Koichiro Yoshioka

摘要

Kounis syndrome is an acute coronary syndrome (ACS) triggered by allergic reactions via mast cell activation, classically accompanied by anaphylaxis. However, ACS associated with mild or subclinical allergic reactions may be underrecognized. We investigated immune markers and autonomic nervous system activity in patients with ACS and characterized allergy-associated ACS without anaphylactic symptoms. Among 375 patients treated for ACS (April 2022 to March 2024), 49 were prospectively enrolled. Patients were classified into non-allergy-associated ACS (ACS-NA, n = 32) and allergy-associated ACS (ACS-AL, n = 17) groups. ACS-AL was subdivided into the non-anaphylactic (ACS-AL(nonA), n = 11) and anaphylactic (ACS-AL(withA), n = 6) groups. Allergic status was comprehensively assessed. Serum IgE and plasma histamine were measured at ACS onset. Heart rate variability (HRV) parameters were analyzed using 24-h ambulatory monitoring within 1 week after percutaneous coronary intervention. The ACS-AL(nonA) and ACS-AL(withA) groups showed significantly higher IgE and histamine levels than the ACS-NA group (P < 0.05), with overlapping distributions. HRV analysis revealed elevated LF/HF ratios and reduced daytime HF in both groups, indicating sympathetic predominance. ACS-AL, even without anaphylaxis, involves immune activation and autonomic imbalance. Combined assessment of IgE, histamine, and HRV may improve the identification of this phenotype.