Reply to “Acute Myocardial Infarction Induced by Anaphylaxis in China: The Kounis Syndrome”

As mentioned in our previous article,[1] a 65-year-old man was admitted to our hospital on September 9, 2016, because of wheals involving the whole body 1 h after ingesting bread and milk. His coexisting symptoms included itchiness, chest discomfort, dyspnea, wheezing, abdominal pain, nausea, vomiting, palpitation, sweating, pale complexion, dizziness, and syncope. His consciousness recovered after taking the Suxiao Jiuxin pill, and then, he was sent to our hospital. His blood pressure dropped to 51/21 mmHg (1 mmHg = 0.133 kPa). The laboratory tests showed that myocardial enzyme increased and a ST elevation of the electrocardiogram. Coronary angiography revealed that the stent was unobstructed.

First, in “Acute Myocardial Infarction Induced by Anaphylaxis in China: The Kounis syndrome,” authors advanced that stent implantation and medication for the coronary heart disease might cause Kounis syndrome, but the patient had stent implantation 5 years ago, and he only had symptoms for 5 times. Hence, we considered the causes induced the symptoms might be food allergy, not stent implantation or medication. Perhaps because the patient did not do exercise after eating allergic food, the symptoms were not so severe. Second, the patient went to subway after having breakfast for half an hour, and then, he had symptoms after walking for another half an hour. The patient walking after breakfast was mentioned in the discussion section of the paper,[1] so food-dependent exercise-induced anaphylaxis was confirmed. Third, the authors’ meaning is that there are no reports of wheat-dependent exercise-induced anaphylaxis resulted in Kounis syndrome in China till now, we are sorry that we did not make it clear.

In the end, we appreciate the author for reading the article carefully, giving professional advice, correcting our negligence, and writing this letter.