Kounis Syndrome After Levofloxacin Intake: A Clinical Report and Cross-reactivity Study

Abstract

Total infusion time: 324 min Volume of each solution administered: solution A,21.25 mL;solution B, 42.25 mL; and solution C, 516.67 mL. Solutions were prepared in the cytotoxicity unit of the pharmacy department. The tubing of each bag is primed with the antineoplastic drug in the pharmacy and connected to a running saline line in close proximity to the patient, thus enabling delivery of small volumes during the initial steps of the desensitization protocol. The protocol was adapted from Castells et al [4]. Irinotecan is always diluted in 500 mL in our hospital, instead of 250 mL, as per the original protocol, and the infusion rate is adapted to that change. No diluent is removed when a solution is prepared owing to our local safety requirements: the amounts added are 0.

Kounis Syndrome After Intake of Levofloxacin: Increasing Incidence of Hypersensitivity to Fluoroquinolones

“…4. We agree with the authors of the report [1] that no diagnostic and therapeutic criteria of Kounis syndrome have been established to date. However, a large group of expert immunologists, allergists, cardiologists, anesthetists, and surgeons has agreed to convene in order to establish these criteria.…”

“…We read with great interest the report published in the Journal of Investigational Allergology and Clinical Immunology [1] of a case of generalized angioedema with urticaria and immediate reaction after intake of levofloxacin by a 35-year-old man with sinusitis who had experienced an episode of type I variant of Kounis syndrome. While the results of the prick and intradermal tests were negative, the basophil activation test yielded a positive result for levofloxacin (4.5%), as did the specific IgE determination.…”

Immunoglobulin E–Mediated Severe Allergy to Hyoscine Butylbromide

“…Diagnosis is based on symptoms and suggestive signs of an acute allergic reaction simultaneously with acute coronary syndrome (angina, vegetative symptoms) related to previous contact with a possible allergen [4,5]. The patient we report, who had no coronary risk factors, had presented 2 episodes of epigastric pain with bilious vomiting during the previous 6 months.…”

“…Although this clinical entity is well-documented, there are many unanswered questions regarding its etiology, pathophysiology, and treatment [3]. In addition, while not rare, KS is infrequently diagnosed [4].…”

Kounis Syndrome: Is it Really a Takotsubo-Like Syndrome?

“…It presents with clinical and electrocardiographic features suggestive of acute myocardial ischemia in the course of an allergic, hypersensitivity, anaphylactic, and anaphylactoid reaction [1,[4][5][6][7] and affects patients of any age or gender [7]. The true estimation of its incidence is unknown.…”