In News:

The recent sudden death of Indian industrialist Sanjay Kapur during a polo match in London has drawn national attention to Kounis Syndrome, a rare but serious medical condition. Reports suggest he may have inhaled a bee, which stung him inside the throat—leading to a cardiac arrest, potentially triggered by an acute allergic reaction. This tragic incident has raised awareness about the interaction between allergic reactions and cardiac emergencies, especially in seemingly healthy individuals.

What is Kounis Syndrome?

Kounis Syndrome is a rare medical condition in which a severe allergic or hypersensitivity reaction triggers a coronary event, such as a heart attack. It is often termed “allergic angina” or “allergic myocardial infarction.”

Mechanism

• Triggered by allergens such as insect stings, drugs, or foods.
• Leads to the activation of mast cells, which release histamine and cytokines.
• These chemicals cause spasms, plaque rupture, or clot formation in coronary arteries.
• Result: Reduced blood flow to the heart, causing ischemia or infarction.

Types of Kounis Syndrome

1. Type I: In individuals with normal coronary arteries – allergic reaction causes artery spasm and possible heart attack.
2. Type II: In those with existing coronary artery disease – allergic reaction destabilizes plaques, causing infarction.
3. Type III: In patients with coronary stents – hypersensitivity leads to thrombosis within stents.

Triggers of Kounis Syndrome

• Insect stings (bee, wasp)
• Medications (NSAIDs, antibiotics)
• Foods (nuts, shellfish, kiwi)
• Environmental allergens (latex, contrast dyes)
• Underlying health conditions (e.g., mastocytosis)

Symptoms

• Chest pain
• Shortness of breath or wheezing
• Swelling (angioedema), hives, or rash
• Low blood pressure
• ECG changes: ST-segment elevation or depression

Diagnosis and Treatment

• Diagnosis: Clinical history, ECG, cardiac enzymes, allergy tests.
• Treatment includes:
  • For allergy: Antihistamines, corticosteroids, epinephrine
  • For cardiac care: Oxygen, nitrates, antiplatelet drugs, beta-blockers

Why Mouth/Throat Bee Stings Are Dangerous

• Immediate airway swelling
• Increased absorption of venom into bloodstream
• Enhanced risk of anaphylaxis and cardiac arrest

Even people without a history of allergy can experience severe reactions if stung inside the mouth or throat.

Warning Signs After a Bee Sting

• Difficulty breathing
• Swollen lips, tongue, or throat
• Rash or itching
• Dizziness or fainting
• Rapid or weak heartbeat
• Nausea or unconsciousness

Immediate emergency care is essential.