Elsevier

Dental Abstracts

Volume 59, Issue 5, September–October 2014, Pages 244-245
Dental Abstracts

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Kounis syndrome

https://doi.org/10.1016/j.denabs.2014.07.018Get rights and content

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Background

In anaphylactic shock the coronary arteries appear to the primary target, producing Kounis syndrome. This disorder is a syndrome associated with panarterial anaphylaxis caused by a growing number of conditions. It can be seen in patients of any age and produces a myriad of clinical manifestations and a wide range of mast cell activation disorders. A Kounis-like syndrome was found to affect the cerebral arteries in association with mast cell activation disorders.

Case Report

Woman, 45, developed anaphylactic shock 10 minutes after a formocresol-soaked cotton pellet was applied to her pulp chamber using zinc phosphate cement. She developed signs of hypersensitivity, including dizziness, shortness of breath, nausea, and unconsciousness, with a systolic blood pressure of 6o mm Hg. She had a history of allergy to ceftriaxone. Adrenaline, corticosteroids, and an intravenous (IV) infusion of 5% dextrose were administered, with the patient regaining consciousness after 23

Analysis

Formocresol and related agents are used as disinfectants for root canal treatment, pulpotomy, and root canal sealants. Mast cells and other interrelated and interacting inflammatory cells participate in allergic and anaphylactic reactions and decisively influence the anaphylactic process. Symptoms such as tiredness, somnolence, or various levels of sleep can be viewed as normal phenomenon after an allergic reaction, but might be symptoms of anaphylaxis caused by reduced brain perfusion as a

Discussion

Mild allergic reactions occur often, but severe anaphylaxis and anaphylactic shock are not as common. An initially mild reaction can develop into a severe or fatal reaction. Everyday dental practice includes the use of several offenders (Table 1). Recently it was noted that patients with increased baseline serum tryptase levels have mast cell disorder and are prone to developing immediate and severe anaphylactic reactions. Elevated salivary levels of mast cell carboxypeptidase may confirm the

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Soufras GD, Kounis GN, Kounis NG: Brain injury due to anaphylactic shock: Broadening manifestations of Kounis syndrome. Int Endod J 47:309-313, 2014

Reprints available from NG Kounis, 7 Aratou St, Queen Olgas Square, Patras 26112, Greece; e-mail: [email protected]

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