{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:38:37Z","timestamp":1783431517021,"version":"3.54.6"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Current knowledge of Kounis syndrome induced by non-steroidal anti-inflammatory drugs (NSAIDs) is based on case reports. This study aimed to investigate the clinical features of Kounis syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Case reports of the NSAIDs-induced Kounis syndrome were analyzed by searching Chinese and English databases from 1 January 1950 to 31 January 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of the 45 included patients (28 women) was 51 years (20\u201380 years). NSAIDs that were the most frequently involved were diclofenac (26.7%, 12\/45), metamizole (15.6%, 7\/45), and aspirin (13.3%, 6\/45). Kounis syndrome occurred mainly within 30 min after administration, with a maximum latency of 1 month. Chest pain (75.6%, 34\/45), dyspnea (33.3%, 15\/45), and allergic reactions (44.4%, 20\/45) were the most common clinical manifestations. Thirty patients (66.7%) had an ST-segment elevation on the electrocardiogram. Echocardiogram and coronary angiography showed abnormalities in 21 patients (75%, 21\/28) and 15 patients (37.5%, 15\/40). Forty-four patients (97.8%) had a good prognosis after treatment with steroids, antihistamines, and vasodilators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The possibility of Kounis syndrome should be considered in the presence of coronary artery disease symptoms when taking NSAIDs. Kounis syndrome can be life-threatening. It is essential to identify and treat Kounis syndrome correctly.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.901522","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T04:55:56Z","timestamp":1657515356000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Analysis of Clinical Features of Non-steroidal Anti-inflammatory Drugs Induced Kounis Syndrome"],"prefix":"10.3389","volume":"9","author":[{"given":"Chunjiang","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijin","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liying","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhen","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuojun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linli","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,11]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/j.1742-1241.1991.tb10251.x","article-title":"Histamine-induced coronary artery spasm: the concept of allergic angina","volume":"45","author":"Kounis","year":"1991","journal-title":"Br J Clin Pract."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1515\/cclm-2016-0010","article-title":"Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management","volume":"54","author":"Kounis","year":"2016","journal-title":"Clin Chem Lab Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1159\/000339204","article-title":"Chronic atherosclerotic mesenteric ischemia that started to develop symptoms just after anaphylaxis","volume":"6","author":"Goto","year":"2012","journal-title":"Case Rep Gastroenterol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.ijcard.2011.05.007","article-title":"Mast cell activation disorders presenting with cerebral vasospasm-related symptoms: a \u201cKounis-like\u201d syndrome?","volume":"150","author":"Gonz\u00e1lez-de-Olano","year":"2011","journal-title":"Int J Cardiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"6784","DOI":"10.2174\/1381612822666160928142814","article-title":"Hypersensitivity reactions to non-steroidal anti-inflammatory drugs","volume":"22","author":"Dona","year":"2016","journal-title":"Curr Pharm Des."},{"key":"B6","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1067\/mai.2001.119028","article-title":"Emergency department anaphylaxis: a review of 142 patients in a single year","volume":"108","author":"Brown","year":"2001","journal-title":"J Allergy Clin Immunol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.ijcard.2011.02.060","article-title":"Allergic reaction reveals a non-lethal late stent thrombosis. A new subtype of Kounis syndrome?","volume":"149","author":"Tsigkas","year":"2011","journal-title":"Int J Cardiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/S0002-9343(98)00091-6","article-title":"Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs","volume":"104","author":"Cryer","year":"1998","journal-title":"Am J Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1111\/all.12260","article-title":"Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs","volume":"68","author":"Kowalski","year":"2013","journal-title":"Allergy."},{"key":"B10","doi-asserted-by":"publisher","first-page":"c7086","DOI":"10.1136\/bmj.c7086","article-title":"Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis","volume":"342","author":"Trelle","year":"2011","journal-title":"BMJ."},{"key":"B11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40266-019-00660-1","article-title":"Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: what does the literature say?","volume":"36","author":"Cooper","year":"2019","journal-title":"Drugs Aging."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1136\/hrt.2011.222448","article-title":"Risk of ST vs. non-ST elevation myocardial infarction associated with non-steroidal anti-inflammatory drugs","volume":"97","author":"Grimaldi-Bensouda","year":"2011","journal-title":"Heart."},{"key":"B13","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.ijcard.2015.10.003","article-title":"Kounis syndrome: an analysis of spontaneous reports from international pharmacovigilance database","volume":"203","author":"Renda","year":"2016","journal-title":"Int J Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1111\/pai.12915","article-title":"EAACI\/ENDA position paper: diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children and adolescents","volume":"29","author":"Kidon","year":"2018","journal-title":"Pediatr Allergy Immunol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijcard.2017.01.124","article-title":"Kounis syndrome: a review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome","volume":"232","author":"Abdelghany","year":"2017","journal-title":"Int J Cardiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"212","DOI":"10.4274\/balkanmedj.galenos.2019.2019.5.62","article-title":"Kounis syndrome-not a single-organ arterial disorder but a multisystem and multidisciplinary disease","volume":"36","author":"Kounis","year":"2019","journal-title":"Balkan Med J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/0162-3109(95)00037-3","article-title":"Immunological characterization and functional importance of human heart mast cells","volume":"31","author":"Marone","year":"1995","journal-title":"Immunopharmacology."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1161\/01.CIR.92.5.1084","article-title":"Infiltrates of activated mast cells at the site of coronary atheromatous erosion or rupture in myocardial infarction","volume":"92","author":"Kovanen","year":"1995","journal-title":"Circulation."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1161\/01.ATV.18.11.1707","article-title":"Activation of matrix-degrading metalloproteinases by mast cell proteases in atherosclerotic plaques","volume":"18","author":"Johnson","year":"1998","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/01.all.0000174158.78626.35","article-title":"Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis","volume":"5","author":"Brown","year":"2005","journal-title":"Curr Opin Allergy Clin Immunol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1586\/eci.10.47","article-title":"Current understanding of kounis syndrome","volume":"6","author":"Biteker","year":"2010","journal-title":"Expert Rev Clin Immunol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"737282","DOI":"10.1155\/2009\/737282","article-title":"Leukotrienes in atherosclerosis: new target insights and future therapy perspectives","volume":"2009","author":"Riccioni","year":"2009","journal-title":"Mediators Inflamm."},{"key":"B23","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.ijcard.2010.02.040","article-title":"Treatment of kounis syndrome","volume":"143","author":"Cevik","year":"2010","journal-title":"Int J Cardiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ijcard.2006.08.039","article-title":"Hymenoptera sting-induced kounis syndrome: effects of aspirin and beta-blocker administration","volume":"121","author":"Ioannidis","year":"2007","journal-title":"Int J Cardiol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.ijcard.2014.11.049","article-title":"Kounis syndrome caused by metronidazole\u2014a case of 14 year-old boy","volume":"179","author":"Terlemez","year":"2015","journal-title":"Int J Cardiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ejim.2015.12.004","article-title":"Kounis syndrome: a concise review with focus on management","volume":"30","author":"Fassio","year":"2016","journal-title":"Eur J Intern Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1161\/01.CIR.90.4.1669","article-title":"Accumulation of activated mast cells in the shoulder region of human coronary atheroma, the predilection site of atheromatous rupture","volume":"90","author":"Kaartinen","year":"1994","journal-title":"Circulation."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1161\/01.CIR.0000142053.13921.21","article-title":"Pharmacological stabilization of mast cells abrogates late thrombotic events induced by diesel exhaust particles in hamsters","volume":"110","author":"Nemmar","year":"2004","journal-title":"Circulation."},{"key":"B30","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1016\/S1081-1206(10)61484-6","article-title":"Mast cells and mast cell mediators as targets of dietary supplements","volume":"93","author":"Theoharides","year":"2004","journal-title":"Ann Allergy Asthma Immunol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"805","DOI":"10.2217\/fca.11.63","article-title":"Kounis syndrome: a new twist on an old disease","volume":"7","author":"Kounis","year":"2011","journal-title":"Future Cardiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijcard.2005.08.007","article-title":"Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?","volume":"110","author":"Kounis","year":"2006","journal-title":"Int J Cardiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"003006","DOI":"10.12890\/2021_003006","article-title":"Kounis syndrome: dexketoprofen-associated ST-elevation myocardial infarction","volume":"8","author":"Aksakal","year":"2021","journal-title":"Eur J Case Rep Intern Med."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.901522\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T12:04:48Z","timestamp":1700827488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.901522\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,11]]},"references-count":33,"alternative-id":["10.3389\/fcvm.2022.901522"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.901522","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,11]]},"article-number":"901522"}}