Allergy-associated ACS patients had significantly higher serum IgE (213.6 ± 221.9 vs. 84.5 ± 73.7 IU/mL, P=0.02) and plasma histamine levels (11.4 ± 8.7 vs. 5.6 ± 3.2 ng/mL, P<0.01) and exhibited increased sympathetic activity with higher LF/HF ratios (daytime 3.5 ± 2.2 vs. 2.5 ± 1.3, P=0.04; nighttime 4.0 ± 2.6 vs. 2.1 ± 1.5, P<0.01) compared to non-allergic ACS patients.
Observational (n=49)
No
Does allergy-associated acute coronary syndrome (with or without anaphylaxis) alter immune markers and autonomic nervous system activity compared to non-allergy-associated ACS?
Allergy-associated ACS, even without overt anaphylaxis, is characterized by elevated immune markers (IgE, histamine) and sympathetic nervous system predominance compared to non-allergy-associated ACS.
Abstract Kounis syndrome is an acute coronary syndrome (ACS) triggered by allergic reactions via mast cell activation, classically accompanied by anaphylaxis. However, ACS associated with mild or subclinical allergic reactions may be underrecognized. We investigated immune markers and autonomic nervous system activity in patients with ACS and characterized allergy-associated ACS without anaphylactic symptoms. Among 375 patients treated for ACS (April 2022 to March 2024), 49 were prospectively enrolled. Patients were classified into non-allergy-associated ACS (ACS-NA, n = 32) and allergy-associated ACS (ACS-AL, n = 17) groups. ACS-AL was subdivided into the non-anaphylactic (ACS-AL(nonA), n = 11) and anaphylactic (ACS-AL(withA), n = 6) groups. Allergic status was comprehensively assessed. Serum IgE and plasma histamine were measured at ACS onset. Heart rate variability (HRV) parameters were analyzed using 24-h ambulatory monitoring within 1 week after percutaneous coronary intervention. The ACS-AL(nonA) and ACS-AL(withA) groups showed significantly higher IgE and histamine levels than the ACS-NA group (P < 0.05), with overlapping distributions. HRV analysis revealed elevated LF/HF ratios and reduced daytime HF in both groups, indicating sympathetic predominance. ACS-AL, even without anaphylaxis, involves immune activation and autonomic imbalance. Combined assessment of IgE, histamine, and HRV may improve the identification of this phenotype.
Amino et al. (Sat,) conducted a observational in Adults diagnosed with acute coronary syndrome (ACS), subdivided into allergy-associated ACS with and without anaphylaxis (n=49). Allergy-associated ACS patients had significantly higher serum IgE (213.6 ± 221.9 vs. 84.5 ± 73.7 IU/mL, P=0.02) and plasma histamine levels (11.4 ± 8.7 vs. 5.6 ± 3.2 ng/mL, P<0.01) and exhibited increased sympathetic activity with higher LF/HF ratios (daytime 3.5 ± 2.2 vs. 2.5 ± 1.3, P=0.04; nighttime 4.0 ± 2.6 vs. 2.1 ± 1.5, P<0.01) compared to non-allergic ACS patients.