Lepirudin anaphylaxis and Kounis syndrome.

Abstract

To the Editor: In an ongoing lepirudin pharmacosurveillance program, Greinacher et al1 reported that 4 patients experienced fatal anaphylaxis after reexposure to lepirudin and died shortly after the onset of the event. Three patients died from acute cardiorespiratory arrest and 1 from acute myocardial infarction. These cases are characteristic examples of drug-induced Kounis syndrome2—the concurrence of allergic or hypersensitivity reactions with acute coronary syndromes.3 Kounis syndrome is caused by certain environmental exposures, poisons, and venoms; conditions such as angioedema, bronchial asthma, exercise-induced anaphylaxis, food allergy, idiopathic anaphylaxis, serum sickness, urticaria, and mastocytosis; drugs via inflammatory mediators such as histamine, tryptase, and chymase; and arachidonic acid products such as leukotrienes. There are several categories of drugs that are capable of inducing Kounis syndrome. These include antibiotics, analgesics, antineoplastics, …