000878 - Kounis Syndrome induced by anaphylaxis after consuming hake

Kounis syndrome (KS) was first described in 1991 as the simultaneous occurrence of acute coronary syndromes (ACS) and anaphylactic allergic reactions.

There are three types of KS. Type I occurs in patients without coronary artery disease, where the most likely mechanism is a vasospastic phenomenon. Type II is characterized by atherosclerotic disease, where plaque ruptures due to the release of anaphylactic mediators. Finally, type III is related to thrombosis of a prior stent.

Diagnosis is clinical and is based on identifying symptoms and signs suggestive of an acute allergic reaction and an acute coronary event occurring simultaneously.

We describe a case of type I KS caused by an allergy to Anisakis after consuming hake.

An 84-year-old female patient with no confirmed allergies, although she reports having experienced generalized urticaria more than 20 years ago after consuming clams, with subsequent tolerance to shellfish, cephalopods, and crustaceans. Cardiological history includes heart failure, and she was investigated for chest pain of low ischemic probability (included normal ergometry, echocardiography and coronary CT angiography).

The patient reported, after consuming fresh hake and orange, immediately nausea and vomiting, followed by pruritus, generalized urticaria, and dyspnea with desaturation, and she was transferred to the emergency department where she received adrenaline, intravenous fluids and high-flow oxygen therapy (ventimask) with good initial evolution. However, two hours after admission, she experienced an episode of oppressive chest pain with mobilization of cardiac enzymes.

She later tolerated different types of fish, except hake, without any issues.

• - EKG: Normal
• - Blood analysis on admission: Mild leukocytosis, rest normal. Triptase level was not determined.
• - High-sensitivity Troponin I: 16 ng/L - 4447 ng/L - 3172 ng/L - 349 ng/L.
• - Basal triptase (one month later): 5.3 µg/L. Total IgE 5158.9 UI/mL.
• - Prick tests: Negative for white fish, Anisakis, shellfish, orange, - aeroallergens, LTP, and profilin.
• - ISAC: Anisakis Ani s 1 Serine protease inhibitor 26 ISU-E.

We present a case of Kounis Syndrome type I (vasospastic reaction) associated with anaphylaxis after the ingestion of hake due to an allergy to Anisakis.