{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:30:41Z","timestamp":1790875841168,"version":"4.1.0"},"reference-count":62,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Mast cell degranulation and other interacting and linked cells, including T-lymphocytes, macrophages, eosinophils, and platelets, as well as a range of inflammatory mediators produced during an anaphylactic or allergic reaction, constitute the main causes of Kounis syndrome. Acute ischemia episodes, coronary spasm, atheromatous plaque erosion\/rupture, and platelet activation can all be caused by histamine, tryptase, arachidonic acid derivatives, and chymase in the Kounis syndrome cascade. Kounis syndrome can be triggered by a variety of factors, including medications, hymenopteran stings, metals, foods, environmental exposures, illnesses, and immunizations. In addition, some unusual, rare, intriguing, and significant causes of Kounis syndrome have been discovered recently, namely the \u201ckiss of death\u201d, where human kissing and pet kissing can induce fatal Kounis syndrome. Moreover, the clinical conundrum is that several of the main drugs and substances used to treat myocardial infarction and Kounis syndrome, such as adrenaline (epinephrine), aspirin, atropine, clopidogrel, corticosteroids, heparins, protamine sulfate, and hirudotherapy can also initiate it. Therefore, physicians should be aware of this clinical discrepancy to prevent catastrophic consequences.<\/jats:p>","DOI":"10.3390\/jcdd12110423","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T04:26:29Z","timestamp":1761711989000},"page":"423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unusual, Uncommon, Intriguing, and Significant Causes of Kounis Syndrome: Important Medications and Chemicals Used to Treat Kounis Syndrome and Myocardial Infarction Can Cause Kounis Syndrome"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9751-6710","authenticated-orcid":false,"given":"Nicholas G.","family":"Kounis","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Patras Medical School, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3022-266X","authenticated-orcid":false,"given":"Cesare","family":"de Gregorio","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina Medical School, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6912-7523","authenticated-orcid":false,"given":"Ming-Yow","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, 18 No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City 23561, Taiwan"},{"name":"Taipei Heart Institute, Taipei Medical University, Taipei City 110301, Taiwan"},{"name":"Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7406-5427","authenticated-orcid":false,"given":"Grigorios","family":"Giamouzis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Larissa, 41334 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2073-8523","authenticated-orcid":false,"given":"Marina A.","family":"Michalaki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology, University of Patras School of Health Sciences, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7552-7654","authenticated-orcid":false,"given":"U\u011fur","family":"\u00d6zkan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0043-9051","authenticated-orcid":false,"given":"Alexandr","family":"Ceasovschih","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1610-0156","authenticated-orcid":false,"given":"Virginia","family":"Mplani","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Patras University Hospital, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Dousdampanis","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Saint Andrews State General Hospital, 26221 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2544-1044","authenticated-orcid":false,"given":"Sophia N.","family":"Kouni","sequence":"additional","affiliation":[{"name":"Speech Therapy Practice, Queen Olgas Square, 26221 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5814-1859","authenticated-orcid":false,"given":"Alexandros","family":"Stefanidis","sequence":"additional","affiliation":[{"name":"First Cardiology Department, General Hospital of Nikea, Agios Panteleimon Piraeus, 3 D. Mantouvalou Street, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3320-408X","authenticated-orcid":false,"given":"Kassiani-Maria","family":"Nastouli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Patras Medical School, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8215-427X","authenticated-orcid":false,"given":"Maria","family":"Bozika","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Patras Medical School, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Patsouras","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Patras Medical School, Rio, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Koniari","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Patras Medical School, Rio, 26500 Patras, Greece"},{"name":"Department of Cardiology, Liverpool Center for Cardiovascular Science, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kei, C.Y., Singh, K., Dautov, R.F., Nguyen, T.H., Chirkov, Y.Y., and Horowitz, J.D. 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