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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Allergic vasospastic angina: a systematic review.

Megan Quetsch1, Frank Kette2, Rosanna Tavella1,3,4

  • 1Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.

Heart (British Cardiac Society)
|November 6, 2025
PubMed
Summary

Allergic vasospastic angina, or Kounis syndrome, is an under-recognized condition where allergens trigger coronary artery spasm. Early diagnosis is crucial for effective management, differing from conventional vasospastic angina treatments.

Keywords:
Acute Coronary SyndromeChest PainCoronary Artery DiseaseMicrovascular Angina

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Area of Science:

  • Cardiology
  • Allergy and Immunology

Background:

  • Allergic vasospastic angina (Kounis syndrome) is a recognized subtype of vasospastic angina.
  • Coronary artery spasm is triggered by an allergen in this condition.

Purpose of the Study:

  • Evaluate clinical characteristics of allergic vasospastic angina.
  • Investigate the mechanisms and management strategies for this condition.

Main Methods:

  • Systematic review of 393 case reports from 1992-2022.
  • Analysis of patient demographics, clinical presentation, and diagnostic investigations.
  • Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main Results:

  • Median patient age was 53 years, with 64% males.
  • 71% presented with ST-elevation myocardial infarct, often linked to prescription medications.
  • Potential mechanisms include IgE-mediated and non-IgE mediated pathways.

Conclusions:

  • Allergic vasospastic angina is an under-recognized cause of acute coronary syndrome.
  • Diagnosis is vital as management differs from conventional vasospastic angina.
  • Allergen avoidance and specific therapies can be beneficial.