Allergy and the cardiovascular system

Abstract

SummaryThe most dangerous and life-threatening manifestation of allergic diseases is anaphylaxis, a condition in which the cardiovascular system is responsible for the majority of clinical symptoms and for potentially fatal outcome. The heart is both a source and a target of chemical mediators released during allergic reactions. Mast cells are abundant in the human heart, where they are located predominantly around the adventitia of large coronary arteries and in close contact with the small intramural vessels. Cardiac mast cells can be activated by a variety of stimuli including allergens, complement factors, general anesthetics and muscle relaxants. Mediators released from immunologically activated human heart mast cells strongly influence ventricular function, cardiac rhythm and coronary artery tone. Histamine, cysteinyl leukotrienes and platelet-activating factor (PAF) exert negative inotropic effects and induce myocardial depression that contribute significantly to the pathogenesis of anaphylactic shock. Moreover, cardiac mast cells release chymase and renin that activates the angiotensin system locally, which further induces arteriolar vasoconstriction. The number and density of cardiac mast cells is increased in patients with ischaemic heart disease and dilated cardiomyopathies. This observation may help explain why these conditions are major risk factors for fatal anaphylaxis. A better understanding of the mechanisms involved in cardiac mast cell activation may lead to an improvement in prevention and treatment of systemic anaphylaxis.

Major Contribution of Vasospasm-Induced Coronary Blood Flow Reduction to Anaphylactic Ventricular Dysfunction Assessed in Isolated Blood-Perfused Rat Heart

“…Anaphylactic shock is sometimes life-threatening and accompanied by cardiac manifestations, which are clinically characterized by acute myocardial ischemia via coronary artery spasm and left ventricular (LV) dysfunction [1][2][3][4][5][6][7][8]. Allergic activation of cardiac must cells is known to be of particular importance as a cause of the acute coronary syndrome, which is called "Kounis syndrome" [9].…”

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

“…The presence of mast cells in the heart and the release of cardiotoxic mediators such as histamine, LTC4, and platelet-activating factor [21], as well as the increase in mast cell counts in the coronary vessels of patients with ischemic heart disease, can render the heart incapable of overcoming the systemic and cardiac effects of anaphylaxis. In addition, the widespread concomitant use of β-blockers and ACE inhibitors in cardiovascular diseases [22,23] has been considered to cause more severe anaphylaxis in patients with heart disease [24]. Our literature review [5,6,24,25] revealed that several markers can be used to assess the severity of anaphylaxis and that not all markers of cardiovascular disease are associated with all severity markers.…”

Knowledge of general practitioners and medical students regarding the diagnosis and treatment of anaphylaxis

“…Yıllık insidansının çocuklarda 75.1/100.000, adölesanlarda ise 65.2/100.000 olduğu bilinmektedir [2]. Çocukluk çağında meydana gelen anaflaksiye bağlı mortalite oranları %0.7 ile %20 arasında değişmektedir [3,4]. Anafilaksiye neden olan en önemli etkenler besinler (%33), venomlar (%19) ve ilaçlardır (%14) [2].…”