Coronary spasm secondary to biphasic anaphylaxis after hymenoptera stings

Medicolegal Implications of Biphasic Anaphylaxis

“…[14][15][16][17] This is through the interaction of histamine with H 1 vascular receptors, and also the rupture of plaques and platelet stimulation through the interaction with FcεRI and FcεRII activating receptors located on the surface of platelets. [14][15][16][17] Tryptase, as one of the most widely used biomarkers of anaphylaxis, may also induce, through different and not fully established enzymatic pathways, plaque disruption or rupture, and the activation of thrombin receptors. [14][15][16][17] These events may cause 3 pathophysiological variants which Kounis described as follows: type I, coronary spasm with or without cardiac enzyme/troponin release and myocardial infarction; type II, coronary spasm in the presence of preexisting atheroma with or without plaque rupture, cardiac enzyme/troponin release, and myocardial infarction.…”

“…In terms of the cardiovascular system, anaphylactic IgE-mediated reactions, whether biphasic or uniphasic, may induce coronary constriction or narrowing. [14][15][16][17] This is through the interaction of histamine with H 1 vascular receptors, and also the rupture of plaques and platelet stimulation through the interaction with FcεRI and FcεRII activating receptors located on the surface of platelets. [14][15][16][17] Tryptase, as one of the most widely used biomarkers of anaphylaxis, may also induce, through different and not fully established enzymatic pathways, plaque disruption or rupture, and the activation of thrombin receptors.…”

“…Type III, thrombosis in subjects with a preexisting coronary stent, with or without cardiac enzyme/troponin release and myocardial infarction, whose aspirated specimens, when stained with hematoxylin-eosin and Giemsa reveal the presence of eosinophils and mast cells, respectively. [14][15][16][17] Episodes of biphasic anaphylaxis were first described in 1984 by Popa and Lerner, 18 who reported 3 cases of the reappearance of anaphylactic IgE-mediated symptoms, and coined the term biphasic anaphylaxis.…”

“…In terms of the cardiovascular system, anaphylactic IgE-mediated reactions, whether biphasic or uniphasic, may induce coronary constriction or narrowing 14–17 …”

“…This is through the interaction of histamine with H 1 vascular receptors, and also the rupture of plaques and platelet stimulation through the interaction with FcεRI and FcεRII activating receptors located on the surface of platelets 14–17 …”