Peri-operative cardiac arrest with ST elevation secondary to gelofusin anaphylaxis — Kounis syndrome in the anaesthetic room

Shah, Geetika; Scadding, Guy W.; Nguyen-Lu, N.; Wigmore, Timothy; Chenzbraun, Adrian; Wechalekar, Kshama; Sharma, R.; Lyon, Alexander R.

doi:10.1016/j.ijcard.2012.09.166

Cited by 25 publications

(16 citation statements)

References 13 publications

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“…Gelofusin is a macromolecule made from succinylated bovine gelatin and is used intravenously as plasma substitute or expander that modifies fluid gelatins. Kounis syndrome associated with perioperative cardiac arrest due to Gelofusin anaphylaxis confirmed with skin prick test has been [38]. Gelatins are proteins derived from collagen obtained from cow and pig bones and the hides and skin of fish that are used in lunch meats and as clarifying agents in wine, juices and other beverages.…”

Section: Etiologymentioning

confidence: 99%

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Kounis¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

311

421

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Kounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature's own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.

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Section: Etiologymentioning

confidence: 99%

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Kounis¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

311

421

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“…Recently, anaphylaxis with cardiovascular symptoms, such as profound hypotension, tachycardia and elevated airway pressure, has been reported following intraosseous gelatin administration (24). In another recent report, a case of Kounis syndrome associated with perioperative cardiac arrest due to Gelofusin anaphylaxis on confirmed on skin prick tests was published (25). That case involved a 57-year-old patient who developed anaphylactic shock while under anesthesia and developed worsening hypotension and lost cardiac output despite initial management with bolus doses of metaraminol and epinephrine administered intravenously.…”

Section: Gelofusin Substancementioning

confidence: 99%

“…To date, allergic reactions have been reported following intramuscular, intraarticular, periarticular, intralesional, oral, inhalation and intravenous corticosteroid administration. The frequency of Type 1 or immediate allergic reactions to systemic corticosteroids has been estimated to range from 0.1 to 0.3% (25). On the other hand, the incidence of Type 4 or delayed allergic reactions to topically applied glucocorticoids is estimated to be between 0.2% and 5% (49,50).…”

Section: Corticosteroid Paradox: Can Corticosteroidsmentioning

confidence: 99%

Foods, Drugs and Environmental Factors: Novel Kounis Syndrome Offenders

Kounis¹,

Giannopoulos

Soufras

et al. 2015

Intern. Med.

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Kounis syndrome is hypersensitivity coronary disorder induced by various types of environmental exposures, drugs, conditions and stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. The disorder manifests as coronary spasms, acute myocardial infarction and stent thrombosis and affects the cerebral and mesenteric as well as coronary arteries. Importantly, its manifestations are broad and its etiology is continuously increasing. Recently, a variety of unusual etiologies have been reported including Anisakis simplex, scombroid syndrome, the use of Gelofusin or ultrasound contrast agents, kiwifruit, fly bites, and bee stings. Furthermore, losartan and the paradox of corticosteroid allergy have been implicated as possible causes. Although not rare, Kounis syndrome is infrequently diagnosed. Therefore, awareness of its etiology, manifestations and pathophysiology is important for providing the proper diagnosis and treatment and determining prognosis.

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“…This syndrome is increasingly recognized in different clinical settings and has been associated with gelofusin 130 , Latex exposure 131 ceftriaxone 132 eosinophilic periarteritis 133 and coronary stents 132, 134-136 . Whether MC are activated upong contact with metal or drug-coated stents remaines to be investigated.…”

Section: Introductionmentioning

confidence: 99%