From Acute Carditis, Rheumatic Carditis, and Morphologic Cardiac Reactions to Allergic Angina, Allergic Myocardial Infarction, and Kounis Syndrome: A Multidisciplinary and Multisystem Disease

• Published in: Journal of cardiovascular development and disease Vol. 12; no. 9; p. 325
• Main Authors: Kounis, Nicholas G., Stefanidis, Alexandros, Hung, Ming-Yow, Özkan, Uğur, de Gregorio, Cesare, Ceasovschih, Alexandr, Mplani, Virginia, Gogos, Christos, Assimakopoulos, Stelios F., Chatzigrigoriadis, Christodoulos, Plotas, Panagiotis, Dousdampanis, Periklis, Kouni, Sophia N., Tsigkas, Grigorios, Patsouras, Nicholas, Calogiuri, Gianfranco, Pourmasumi, Soheila, Koniari, Ioanna
• Format: Journal Article
• Language: English
• Published: 25.08.2025
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd12090325

This narrative review explains the history of anaphylactic or hypersensitivity reactions, their connection to the cardiovascular system, and Kounis syndrome, which is linked to hypersensitivity. Additional subjects discussed include immunoglobulin E and serum tryptase, common pathways of allergic and nonallergic cardiovascular events, current perspectives on Kounis syndrome, allergic myocardial infarction, allergic angina, and the impact of COVID-19 and its vaccination on Kounis syndrome. Kounis syndrome is a distinct kind of acute vascular disease that affects the coronary, cerebral, mesenteric, peripheral, and venous systems. Kounis syndrome is currently used to describe coronary symptoms linked to disorders involving mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, which further induce allergic, hypersensitive, anaphylactic, or anaphylactic insults. Platelet activating factor, histamine, neutral proteases like tryptase and chymase, arachidonic acid products, and a range of cytokines and chemokines released during the activation process are among the inflammatory mediators that cause it. Proinflammatory cytokines are primarily produced by mast cells in COVID-19 infections. Mast cell-derived proteases and eosinophil-associated mediators are also more prevalent in the lung tissues and sera of COVID-19 patients. As a modern global threat to civilization, COVID-19 is linked to chemical patterns that can activate mast cells; therefore, allergic stimuli are usually the reason. Virus-associated molecular patterns can activate mast cells, but allergic triggers are typically the cause. By activating SARS-CoV-2 and other toll-like receptors, a variety of proinflammatory mediators, including IL-6 and IL-1β, are released, potentially contributing to the pathology of COVID-19.