{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:59:37Z","timestamp":1790657977809,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and are generally considered to have a favourable safety profile. Nevertheless, immediate hypersensitivity reactions may occur and, in exceptional circumstances, can precipitate Kounis syndrome (KS), an acute coronary syndrome resulting from the activation of inflammatory pathways. We describe an elderly patient who developed severe anaphylaxis with Type I KS shortly after intravenous pantoprazole administration in the presence of an unsuspected myocardial bridge, and discuss the potential clinical implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 85-year-old woman with a 30-year history of well-controlled bronchial asthma was admitted with community-acquired pneumonia. During hospitalization, she received intravenous pantoprazole (40\u2005mg) for acid reflux. Within five minutes of the infusion, she developed a widespread erythematous rash, severe bronchospasm, profound hypotension (74\/56 mmHg), and ST-segment elevation of approximately 0.3\u2005mV in leads I, aVL, and V\u2081 to V\u2084. Emergency coronary angiography demonstrated no obstructive coronary artery disease but identified a myocardial bridge involving the mid-left anterior descending artery, producing nearly 90% systolic compression. Serial cardiac troponin and NT-proBNP concentrations remained within the normal range. Assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of six, indicating a probable causal relationship between pantoprazole and the adverse event. The patient was treated with methylprednisolone (80\u2005mg). The recovery occurred within 2\u2005h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that intravenous pantoprazole may rarely trigger life-threatening Type I Kounis syndrome. It also raises the possibility that a pre-existing myocardial bridge can accentuate coronary vasospasm during severe allergic reactions, thereby contributing to the clinical presentation. Based on this experience and the available literature, we propose a practical management algorithm to facilitate timely diagnosis and treatment in similar clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1883834","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:47:04Z","timestamp":1790657224000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pantoprazole-induced anaphylactic asthma and Type I Kounis syndrome: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Ailing","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Chengdu Pidu District Hospital of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songyun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haseeb","family":"Sattar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Urban Vocational College of Sichuan","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalu","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chengdu Pidu District Hospital of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaixin","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chengdu Pidu District Hospital of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Urban Vocational College of Sichuan","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.3390\/medicina61091569","article-title":"Proton pump inhibitors (PPIs) \u2014 an evidence-based review of indications, efficacy, harms, and deprescribing","volume":"61","author":"Andrawes","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"471","DOI":"10.2500\/aap.2025.46.250073","article-title":"Evaluation of diagnostic tests for suspected hypersensitivity reactions to proton pump inhibitors in children","volume":"46","author":"Yilmaz","year":"2025","journal-title":"Allergy Asthma Proc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"004017","DOI":"10.12890\/2023_004017","article-title":"Anaphylaxis caused by taking pantoprazole: case series","volume":"10","author":"Telaku","year":"2023","journal-title":"Eur J Case Rep Intern Med"},{"key":"B4","doi-asserted-by":"publisher","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":"B5","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2174\/011871529X305833240708051508","article-title":"Kounis syndrome: review of clinical cases","volume":"24","author":"Yakushin","year":"2024","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"key":"B6","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.iac.2022.10.010","article-title":"Allergic acute coronary syndrome \u2014 Kounis syndrome","volume":"43","author":"Alblaihed","year":"2023","journal-title":"Immunol Allergy Clin North Am"},{"key":"B7","doi-asserted-by":"publisher","first-page":"212","DOI":"10.4274\/balkanmedj.galenos.2019.2019.5.62","article-title":"Kounis syndrome \u2014 not a single-organ arterial disorder but a multisystem and multidisciplinary disease","volume":"36","author":"Kounis","year":"2019","journal-title":"Int J Cardiol"},{"key":"B8","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":"B9","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1016\/j.ijcard.2011.11.059","article-title":"Allergic reaction to proton pump inhibitor: pantoprazole induced Kounis syndrome","volume":"159","author":"Canpolat","year":"2012","journal-title":"Int J Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e254799","DOI":"10.1136\/bcr-2023-254799","article-title":"Unexpected cause of Kounis syndrome: hypersensitivity reaction to omeprazole","volume":"16","author":"Erdem","year":"2023","journal-title":"BMJ Case Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e62","DOI":"10.1016\/j.ijcard.2007.12.099","article-title":"Hypersensitivity to proton pump inhibitors: lansoprazole-induced Kounis syndrome","volume":"134","author":"Vlahos","year":"2009","journal-title":"Int J Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3390\/diagnostics10020059","article-title":"Type I Kounis syndrome after protracted anaphylaxis and myocardial bridge \u2014 brief literature review and case report","volume":"10","author":"Ghilencea","year":"2020","journal-title":"Diagnostics (Basel)"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/490310","article-title":"Kounis syndrome together with myocardial bridging leading to acute myocardial infarction at young age","author":"Caglar","year":"2011","journal-title":"Case Rep Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin Pharmacol Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"100152","DOI":"10.1016\/j.jacig.2023.100152","article-title":"Kounis syndrome: sT elevations in the setting of anaphylaxis","volume":"2","author":"Cesarz","year":"2023","journal-title":"J Allergy Clin Immunol Glob"},{"key":"B16","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1097\/CRD.0000000000000436","article-title":"Kounis syndrome: a review of an uncommon cause of acute coronary syndrome","volume":"31","author":"Douedi","year":"2023","journal-title":"Cardiol Rev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40521-023-00342-9","article-title":"Drug-induced Kounis syndrome: latest novelties","volume":"10","author":"Ollo-Morales","year":"2023","journal-title":"Curr Treat Options Allergy"},{"key":"B18","doi-asserted-by":"publisher","first-page":"103","DOI":"10.2500\/ar.2017.8.0198","article-title":"Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis","volume":"8","author":"Sandhu","year":"2017","journal-title":"Allergy Rhinol (Providence)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1016\/j.jacc.2021.09.859","article-title":"Myocardial bridging: diagnosis, functional assessment, and management: jACC state-of-the-art review","volume":"78","author":"Sternheim","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1080\/1744666X.2018.1505504","article-title":"Anaphylaxis due to proton pump inhibitors: current understanding and important clinical considerations","volume":"14","author":"Benito-Garcia","year":"2018","journal-title":"Expert Rev Clin Immunol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1111\/all.15961","article-title":"Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper","volume":"79","author":"Bavbek","year":"2024","journal-title":"Allergy"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.2500\/aap.2020.41.190033","article-title":"Hypersensitivity reactions to proton-pump inhibitors: clinical presentation, diagnosis, and management","volume":"41","author":"Kepil \u00d6zdemir","year":"2020","journal-title":"Allergy Asthma Proc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.ajem.2021.07.001","article-title":"Kounis syndrome and anaphylaxis","volume":"56","author":"Jolobe","year":"2022","journal-title":"Am J Emerg Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.32725\/jab.2023.010","article-title":"Causality assessment of adverse drug reaction: a narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings[J]","volume":"21","author":"Pradhan","year":"2023","journal-title":"J Appl Biomed"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e238300","DOI":"10.14503\/THIJ-23-8300","article-title":"Coronary myocardial bridge updates: anatomy, pathophysiology, clinical manifestations, diagnosis, and treatment options","volume":"52","author":"Angelini","year":"2025","journal-title":"Tex Heart Inst J"},{"key":"B26","doi-asserted-by":"publisher","first-page":"3955","DOI":"10.1053\/j.jvca.2022.06.024","article-title":"Myocardial bridge: diagnosis, treatment, and challenges","volume":"36","author":"Freiling","year":"2022","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B27","doi-asserted-by":"publisher","first-page":"133057","DOI":"10.1016\/j.ijcard.2025.133057","article-title":"Kounis syndrome: diagnostic approach and management considerations","volume":"425","author":"Yale","year":"2025","journal-title":"Int J Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1883834\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:47:12Z","timestamp":1790657232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1883834\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":27,"alternative-id":["10.3389\/fcvm.2026.1883834"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1883834","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"1883834"}}