{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:19:58Z","timestamp":1791537598900,"version":"4.3.4"},"reference-count":54,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T00:00:00Z","timestamp":1437436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Cardiovascular disease (<jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>) increases the risk of severe or fatal anaphylaxis, and some medications for CVD treatment can exacerbate anaphylaxis. The aim of this article is to review the effect of anaphylaxis on the heart, the potential impact of medications for <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content> on anaphylaxis and anaphylaxis treatment, and the cardiovascular effects of epinephrine. The therapeutic dilemmas arising from these issues are also discussed and management strategies proposed. PubMed searches were performed for the years 1990\u20132014 inclusive, using terms such as angiotensin\u2010converting enzyme (<jats:styled-content style=\"fixed-case\">ACE<\/jats:styled-content>) inhibitors, adrenaline, allergic myocardial infarction, anaphylaxis, angiotensin\u2010receptor blockers (<jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>s), beta\u2010adrenergic blockers, epinephrine, and Kounis syndrome. Literature analysis indicated that: cardiac mast cells are key constituents of atherosclerotic plaques; mast cell mediators play an important role in acute coronary syndrome (ACS); patients with CVD are at increased risk of developing severe or fatal anaphylaxis; and medications for <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content> treatment, including beta\u2010adrenergic blockers and <jats:styled-content style=\"fixed-case\">ACE<\/jats:styled-content> inhibitors, potentially exacerbate anaphylaxis or make it more difficult to treat. Epinephrine increases myocardial contractility, decreases the duration of systole relative to diastole, and enhances coronary blood flow. Its transient adverse effects include pallor, tremor, anxiety, and palpitations. Serious adverse effects (including ventricular arrhythmias and hypertension) are rare, and are significantly more likely after intravenous injection than after intramuscular injection. Epinephrine is life\u2010saving in anaphylaxis; second\u2010line medications (including antihistamines and glucocorticoids) are not. In CVD patients (especially those with <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>), the decision to administer epinephrine for anaphylaxis can be difficult, and its benefits and potential harms need to be carefully considered. Concerns about potential adverse effects need to be weighed against concerns about possible death from untreated anaphylaxis, but there is no absolute contraindication to epinephrine injection in anaphylaxis.<\/jats:p>","DOI":"10.1111\/cea.12520","type":"journal-article","created":{"date-parts":[[2015,2,25]],"date-time":"2015-02-25T06:12:58Z","timestamp":1424844778000},"page":"1288-1295","source":"Crossref","is-referenced-by-count":87,"title":["Anaphylaxis and cardiovascular disease: therapeutic dilemmas"],"prefix":"10.1111","volume":"45","author":[{"given":"P.","family":"Lieberman","sequence":"first","affiliation":[{"name":"Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology) University of Tennessee College of Medicine Germantown TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. E. 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