Epinephrine and the paradox of Kounis syndrome: a case series and review of management.

BACKGROUND

Epinephrine, the primary treatment for anaphylaxis, may paradoxically worsen underlying myocardial ischaemia due to its vasoconstrictive effects and potential to trigger vasospasm during an inflammatory response.

CASE SUMMARY: We present two cases of Kounis syndrome-one in a patient who developed Prinzmetal angina after exposure to shellfish and another who experienced cardiac arrest after receiving intramuscular epinephrine for an anaphylactic reaction to a wasp sting.

DISCUSSION: These cases emphasize the potential for anaphylaxis to precipitate acute coronary syndrome which can paradoxically be exacerbated by the routine administration of epinephrine in susceptible individuals, underscoring the importance of heightened vigilance and consideration of alternative therapies when Kounis syndrome is suspected.