Antibodies against antibodies inducing Kounis syndrome

摘要

Kounis syndrome is hypersensitivity associated acute coronary syndrome resulting from the action of inflammatory mediators released during an allergic or anaphylactic episode. When 2000 nearby antibodies attached to mast cell surface are bridged by corresponding antigens and make the critical number of 1000 bridges, then mast cell degranulation ensues and a variety of inflammatory mediators are released locally and in the systemic circulation. Such mediators can induce either coronary artery spasm which can progress to acute myocardial infarction or atheromatous plaque erosion or rupture culminating to coronary thrombosis. This is a classical pathway to induce an allergic or anaphylactic episode. However, there are reports according to which antibodies are themselves acting as antigens able to bridge corresponding antigens in mast cell surface and induce an acute coronary event manifesting as Kounis syndrome.