Anti-vasospastic mast cell stabilizers: a novel therapeutic approach to anaphylaxis-induced acute coronary syndrome

Kounis syndrome is an acute myocardial infarction caused by severe allergic reactions or anaphylaxis following vaccination and other triggers, with the associated release of chemical mediators from mast cells causing coronary artery vasospasm. However, treatment with adrenaline is controversial as it paradoxically aggravates cardiac ischemia. Among the many a₁-adrenergic receptor blockers, calcium channel blockers, endogenous vasodilators, and antioxidants that can ameliorate coronary artery vasospasm are some (e.g., prazosin, verapamil, diltiazem, magnesium and vitamin C) that can also stabilize mast cells. Given their dual pharmacological efficacies, these substances may be valuable treatments for Kounis syndrome following coronavirus disease 2019 and other vaccinations.