Kounis syndrome caused by double allergens: the more allergens present the easier the quicker and the more severe the anaphylaxis

摘要

To the Editor: In the very interesting report published in the Chinese Medical Journal,[1] a 42-year-old Chinese male patient who had not any previous history of cardiovascular disease, but only bee stings without any sequelae, was stung again while was cycling outdoors. Immediately, he developed sweats, dizziness, headaches, bosom frowsty, shortness of breath, urinary incontinence, hypotension, hypoxygenation, tachycardia, confusion, ST-segment depression in II-III leads, and ST-segment elevation in aVR, eosinophilia, increased cardiac enzymes, but with normal coronary arteries on angiography, compatible with Kounis type I variant progressing to acute myocardial infarction.[2,3] In this patient; however, specific immunoglobulin tests were positive for tree combination (willow/poplar/elm). The patient had complete recovery with anti-allergic medications and fluid replacement.