{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:23:35Z","timestamp":1779927815657,"version":"3.53.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Pharm Health Care Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kounis syndrome (KS) is an acute coronary syndrome (ACS) triggered by allergic reactions and is frequently associated with antibiotic exposure. However, patient characteristics of antibiotic-associated KS cases are not well described. Some cases with KS-consistent symptoms may instead be reported as antibiotic-associated allergic coronary events (non-KS) without proper diagnosis. Characterizing these non-KS events may improve the accurate diagnosis of KS. This study explores the clinical features of antibiotic-associated KS and non-KS allergic coronary events in the FDA Adverse Event Reporting System (FAERS) and generates hypotheses regarding potential underdiagnosis and improved recognition of KS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>FAERS reports (September 2012\u2013December 2024) were screened for allergic symptoms (SMQ: Anaphylactic reaction; Hypersensitivity) and ACS (SMQ: Acute myocardial infarction) with antibiotics listed as suspected drugs. After exclusions, 459 cases (KS: 205; non-KS: 254) were included. Extracted variables included demographics, comorbidities, drug use (ATC classification), and outcomes. Logistic regression identified factors independently associated with non-KS classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Non-KS group exhibited higher rates of cardiac comorbidities, diabetes, and mortality (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Among suspected antibiotics, penicillins were the only class more frequently reported in KS cases (42% vs. 30%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). In the multivariable analysis, factors independently associated with non-KS classification included female sex (odds ratio [OR]\u2009=\u20091.804), fatal outcomes (OR\u2009=\u20094.320), and use of quinolones (OR\u2009=\u200911.108), aminoglycosides (OR\u2009=\u20093.480), renin\u2013angiotensin agents (OR\u2009=\u20092.608), analgesics (OR\u2009=\u20092.055), and polypharmacy (OR\u2009=\u20093.314) (area under the curve\u2009=\u20090.815).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These exploratory findings indicate that non-KS allergic coronary events, characterized by higher comorbidities, mortality, and proportion of cases reporting the use of quinolones or aminoglycosides, may suggest a potential relationship between non-KS coronary events and KS underdiagnosis, warranting further prospective investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40780-026-00545-7","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T07:46:41Z","timestamp":1770104801000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative clinical features of antibiotic-associated Kounis syndrome and non-Kounis allergic coronary events: a disproportionality analysis using U.S. Food and Drug Administration Adverse Event Reporting System"],"prefix":"10.1186","volume":"12","author":[{"given":"Ichiro","family":"Nakakura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Mukai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuki","family":"Hosoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiro","family":"Ohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Yamanishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaya","family":"Uno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouichi","family":"Hosomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiko","family":"Une","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"545_CR1","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1515\/cclm-2016-0010","volume":"54","author":"NG Kounis","year":"2016","unstructured":"Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med. 2016;54:1545\u201359. https:\/\/doi.org\/10.1515\/cclm-2016-0010.","journal-title":"Clin Chem Lab Med"},{"key":"545_CR2","doi-asserted-by":"publisher","first-page":"132606","DOI":"10.1016\/j.ijcard.2024.132606","volume":"418","author":"NL Cahuapaza-Gutierrez","year":"2025","unstructured":"Cahuapaza-Gutierrez NL, Calderon-Hernandez CC, Chambergo-Michilot D, De Arruda-Chaves E, Zamora A, Runzer-Colmenares FM. Clinical characteristics, management, diagnostic findings, and various etiologies of patients with Kounis syndrome. A systematic review. Int J Cardiol. 2025;418:132606. https:\/\/doi.org\/10.1016\/j.ijcard.2024.132606.","journal-title":"Int J Cardiol"},{"key":"545_CR3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.ijcard.2019.06.002","volume":"292","author":"R Desai","year":"2019","unstructured":"Desai R, Parekh T, Patel U, et al. 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