{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:13:12Z","timestamp":1791724392094,"version":"4.3.4"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epinephrine, the primary treatment for anaphylaxis, may paradoxically worsen underlying myocardial ischaemia due to its vasoconstrictive effects and potential to trigger vasospasm during an inflammatory response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>We present two cases of Kounis syndrome\u2014one in a patient who developed Prinzmetal angina after exposure to shellfish and another who experienced cardiac arrest after receiving intramuscular epinephrine for an anaphylactic reaction to a wasp sting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These cases emphasize the potential for anaphylaxis to precipitate acute coronary syndrome which can paradoxically be exacerbated by the routine administration of epinephrine in susceptible individuals, underscoring the importance of heightened vigilance and consideration of alternative therapies when Kounis syndrome is suspected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf414","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:45:07Z","timestamp":1755863107000},"source":"Crossref","is-referenced-by-count":8,"title":["Epinephrine and the paradox of Kounis syndrome: a case series and review of management"],"prefix":"10.1093","volume":"9","author":[{"given":"Mohammad","family":"Hamideh","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, HCA Houston Healthcare\u2014Kingwood\/University of Houston College of Medicine , 22999 US-59 N, Houston, TX 77339 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, HCA Houston Healthcare\u2014Kingwood\/University of Houston College of Medicine , 1313 Hermann Dr, Houston, TX 77004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aswin","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, HCA Houston Healthcare\u2014Kingwood\/University of Houston College of Medicine , 1313 Hermann Dr, Houston, TX 77004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shudipan","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Fellowship\u2014University of Nevada , 4505 S. Maryland Pkwy, Las Vegas, NV ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mercy Health\u2014St. Rita\u2019s Medical Center , 730 West Market Street, Lima, OH 45801 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakash","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mercy Health\u2014St. Rita\u2019s Medical Center , 730 West Market Street, Lima, OH 45801 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2932-6525","authenticated-orcid":false,"given":"Hafez","family":"Golzarian","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, HCA Houston Healthcare\u2014Kingwood\/University of Houston College of Medicine , 1313 Hermann Dr, Houston, TX 77004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"2025092001303225200_ytaf414-B1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijcard.2019.06.002","article-title":"Epidemiology of acute coronary syndrome co-existent with allergic\/hypersensitivity\/anaphylactic reactions (Kounis syndrome) in the United States: a nationwide inpatient analysis","volume":"292","author":"Desai","year":"2019","journal-title":"Int J Cardiol"},{"key":"2025092001303225200_ytaf414-B2","doi-asserted-by":"crossref","first-page":"2432958","DOI":"10.1155\/2017\/2432958","article-title":"Role of the cysteinyl leukotrienes in the pathogenesis and progression of cardiovascular diseases","volume":"2017","author":"Colazzo","year":"2017","journal-title":"Mediators Inflamm"},{"key":"2025092001303225200_ytaf414-B3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.pharmthera.2019.03.008","article-title":"Mast cell tryptase\u2014marker and maker of cardiovascular diseases","volume":"199","author":"Mohajeri","year":"2019","journal-title":"Pharmacol Ther"},{"key":"2025092001303225200_ytaf414-B4","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ijcard.2004.10.023","article-title":"Serum tryptase levels in acute coronary syndromes","volume":"104","author":"Kervinen","year":"2005","journal-title":"Int J Cardiol"},{"key":"2025092001303225200_ytaf414-B5","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s12872-017-0670-7","article-title":"Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?","volume":"17","author":"Jayamali","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"2025092001303225200_ytaf414-B6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s13256-017-1310-7","article-title":"Management of Kounis syndrome: two case reports","volume":"11","author":"Omri","year":"2017","journal-title":"J Med Case Rep"},{"key":"2025092001303225200_ytaf414-B7","doi-asserted-by":"crossref","first-page":"e7121","DOI":"10.1002\/ccr3.7121","article-title":"Kounis syndrome in a patient with multivessel coronary artery disease and DRESS","volume":"11","author":"La Cognata","year":"2023","journal-title":"Clin Case Rep"},{"key":"2025092001303225200_ytaf414-B8","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0091-6749(74)90080-3","article-title":"Aspirin intolerance I. 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