The management of these patients may be challenging for clinicians. Although beta blockers can be beneficial in ACS, they are contraindicated in<unk> . In allergic ACS, blocking beta receptors while giving epinephrine (which is the basis of treatment of anaphylaxis) can lead to an unopposed activity of α-adrenergic receptors which would aggravate the coronary spasm. Also opioids, indicated to relieve chest pain, may induce massive mast cell degranulation which in turn will worsen the anaphylaxis. They should hence be given carefully in such patients Type I variant Type I variant is treated based on its clinical presentation and how severe the allergic reaction is. If it is a mild reaction, then antihistamines and corticosteroids can help control the symptoms. If the patient’s presentation involves anaphylaxis, intramuscular adrenaline should be given. Treatment of the allergic event alone can abolish type I variant. Giving vasodilators such as nitroglycerin or calcium channel blockers is recommended. Consequences include hypotension and worsening of anaphylaxis. Antihistamine and mast cell stabilizers e.g. cromoglicate or nedocromil can be also considered. Type II variant Acute coronary event protocol is applied and type II can be treated similarly to type I for cardiac symptom control. Glucagon may be a better option than adrenaline for acute anaphylaxis in patients with prior use of chronic beta-blockers. In addition, beta-blockers can increase coronary vasospasm and ischemia. Opiates should be used with caution. Type III variant In addition to the application of the acute coronary syndrome protocol, thrombus aspiration, and placing a new stent is needed. The use of mast cell stabilizers in association with steroids and antihistamines are recommended. Harvesting of intrastent thrombus together with histological examination of aspirated material and staining for eosinophils and mast cells should be undertaken. When allergic symptoms are present following stent implantation, desensitization measures should be applied.
Kounis syndrome
Kufor–Rakeb syndrome
Zunich–Kaye syndrome
STAR syndrome
Simpson–Golabi–Behmel syndrome
RAPADILINO syndrome
Qazi–Markouizos syndrome
Malouf syndrome