Refractory variant angina with a seasonal trend treated with sarpogrelate hydrochloride

A 68-year-old man was referred to our hospital for the evaluation and treatment of chest discomfort and syncope. He was diagnosed with variant angina by prolonged ischemic episode with ST-segment elevation in leads II, III, and aV_F. His symptoms had a seasonal trend and occurred only from April to September. In other seasons, he had no symptoms even with no medication. He had a history of nasal polyps and allergic rhinitis. His symptoms increased in frequency and intensity, and the attacks were not fully controlled by multiple drug therapy. Sarpogrelate hydrochloride, however, resulted in complete resolution of his symptoms. Further examination revealed that he was allergic to mites, Dermatophagoides farina, which were prevalent mainly from April to September. The allergic mechanism was suggested to be involved in the seasonal variety in angina attacks. <Learning objective: We present a 68-year-old male with variant angina. Seasonal variation in his frequency of the attacks suggested the involvement of allergic reactions. While medications including calcium channel blockers and nitrates failed to suppress the angina attack, adding sarpogrelate, a selective 5-HT2A antagonist, significantly prevented symptoms of recurrent coronary vasospasm. Allergic mechanism was suggested to be involved in the pathogenesis of coronary vasospasm in this case.>.