Kounis syndrome should be excluded when physicians treat patients with anaphylaxis

The article, "Epinephrine Use for Anaphylaxis: Too Seldom, Too Late," by Chooniedass et al1 was an interesting read. Therefore, we would like to introduce Kounis syndrome, which is defined as the concurrence of acute coronary syndromes with conditions associated with mast cell and platelet activation and involving interrelated and interacting inflammatory cells in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults.2 Akoz et al3 reported that the annual incidence of Kounis syndrome at the emergency department among all admissions and patients with allergy was 19.4 per 100,000 (27 of 138,911) and 3.4% (27 of 793), respectively.

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