{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:29Z","timestamp":1791521429119,"version":"4.3.4"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016834","name":"Chongqing Municipal Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016834","id-type":"DOI","asserted-by":"publisher"}]}],"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>Kounis syndrome manifests as an acute coronary syndrome induced by an allergic or hypersensitivity reaction. Kounis syndrome consists of three types: Type I is characterized by coronary artery spasm in normal or near-normal arteries, Type II by the rupture of coronary artery plaques, and Type III by the formation of thrombus within the coronary artery stent. Recurrent episodes of Kounis syndrome are uncommon in clinical practice. We herein report a case of recurrent Kounis syndrome, in which the second episode presented as Type III Kounis syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a patient who experienced two acute coronary events triggered by Kounis syndrome within approximately one month\u2014an uncommon presentation. One episode manifested as chest pain accompanied by tongue swelling, and was diagnosed as Type II Kounis syndrome and treated with cetirizine for anti-allergic purposes. The second episode occurred about one month later with persistent chest pain and recurrent tongue swelling, and coronary angiography confirmed acute coronary stent thrombosis. Taken together with the allergic manifestation (tongue swelling) accompanying both events, the second episode fulfilled the criteria for Type III Kounis syndrome. Subsequently, we performed emergency procedures to open the blocked coronary artery and administered glucocorticoid therapy. The patient's symptoms improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite antihistamine therapy with cetirizine in the first episode, this patient still developed subsequent stent-related thrombosis. This case highlights that combined anti-allergic therapy including glucocorticoids may be considered at an early stage for Kounis syndrome patients with unidentified allergens, to mitigate potential allergic-mediated cardiac risk. Nevertheless, we cannot conclude glucocorticoids definitely prevent stent thrombosis, as avoidance of unrecognized allergens may also contribute to clinical improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1948247","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:27:03Z","timestamp":1791520023000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Recurrent Kounis syndrome complicated with acute coronary stent thrombosis"],"prefix":"10.3389","volume":"13","author":[{"given":"Yong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, People\u2019s Hospital of Fengjie","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanwen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, People\u2019s Hospital of Fengjie","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, People\u2019s Hospital of Fengjie","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qidong","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, People\u2019s Hospital of Fengjie","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.emc.2021.08.010","article-title":"Allergic acute coronary syndrome-kounis syndrome","volume":"40","author":"Alblaihed","year":"2022","journal-title":"Emerg Med Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","first-page":"878","DOI":"10.7196\/SAMJnew.8767","article-title":"Kounis syndrome","volume":"105","author":"Ntuli","year":"2015","journal-title":"S Afr Med J"},{"key":"B3","first-page":"301","article-title":"Drug-induced kounis syndrome: latest novelties","volume-title":"Curr Treat Options Allergy","author":"Ollo-Morales","year":"2023"},{"key":"B4","doi-asserted-by":"publisher","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":"B5","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 Pr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1196\/annals.1366.025","article-title":"The critical role of mast cells in allergy and inflammation","volume":"1088","author":"Theoharides","year":"2006","journal-title":"Ann N Y Acad Sci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.clinthera.2013.02.022","article-title":"Coronary hypersensitivity disorder: the kounis syndrome","volume":"35","author":"Kounis","year":"2013","journal-title":"Clin Ther"},{"key":"B8","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3390\/life14010091","article-title":"An insight into Kounis syndrome: bridging clinical knowledge with forensic perspectives","volume":"14","author":"Forzese","year":"2024","journal-title":"Life"},{"key":"B9","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. 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