que se leu este artigo
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"copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2017;36:483" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1499 "formatos" => array:3 [ "EPUB" => 177 "HTML" => 932 "PDF" => 390 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to the Letter to the Editor: “Quinolone-induced hypersensitivity reactions and the Kounis syndrome”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "483" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor «<span class="elsevierStyleHsp" style=""></span>Reações de hipersensibilidade induzidas por quinolona e a síndrome de 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"cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Quinolone-induced hypersensitivity reactions and the Kounis syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "481" "paginaFinal" => "482" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ioanna Koniari, Nicholas G. Kounis, George Soufras, Grigorios Tsigkas, George Hahalis" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ioanna" "apellidos" => "Koniari" ] 1 => array:4 [ "nombre" => "Nicholas G." "apellidos" => "Kounis" "email" => array:1 [ 0 => "ngkounis@otenet.gr" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "George" "apellidos" => "Soufras" ] 3 => array:2 [ "nombre" => "Grigorios" "apellidos" => "Tsigkas" ] 4 => array:2 [ "nombre" => "George" "apellidos" => "Hahalis" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology University of Patras Medical School, Rion, Patras, Achaia, Greece" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Reações de hipersensibilidade induzidas por quinolona e a síndrome de Kounis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the very interesting paper by João Almeida et al. published in the <span class="elsevierStyleItalic">Journal</span>,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> an 85-year-old hypertensive man, a former smoker, allergic to quinolones, with bladder cancer and chronic kidney disease and taking hydroxyzine and alprazolam, developed a type I variant Kounis syndrome in the operating theater immediately after administration of ciprofloxacin. Following suspension of ciprofloxacin and treatment with morphine, aspirin and ticagrelor the patient recovered. Coronary arteriography was normal, troponin was slightly elevated and the patient had leukocytosis with neutrophilia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This report raises important questions concerning the role of the drugs the patient had taken before the operation, quinolone treatment, the presence of neutrophilia and morphine administration.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0015" class="elsevierStylePara elsevierViewall">The described patient was allergic to quinolones and was taking the antihistaminic agent hydroxyzine and the benzodiazepine-class anxiolytic alprazolam, followed by administration of ciprofloxacin in the operating theater. He developed constricting chest discomfort associated with dyspnea, sweating and hypotension. Hydroxyzine and alprazolam can rarely and unexpectedly induce allergic reactions such as cutaneous drug eruption<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and cold-induced urticaria,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> respectively. It seems likely that these three agents could have acted as a dangerous antigenic triplet able to induce allergic mediator release and Kounis syndrome. Indeed, clinical studies have shown that atopic patients allergic to and simultaneously exposed to several antigens have more symptoms than monosensitized individuals.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> At the same time, IgE antibodies with different specificities can have an additive effect, and even sub-threshold numbers of these antibodies can join forces and trigger allergic mediator release when the patient is simultaneously exposed to the corresponding antigens.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fluoroquinolones are generally considered well-tolerated antibiotics, but their consumption is steadily increasing. Kounis syndrome has been induced not only by ciprofloxacin, but also by levofloxacin<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> and the original quinolone cinoxacin.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Indeed, ciprofloxacin-induced Kounis syndrome, apart from the case currently under discussion, has been reported in one additional case.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is anticipated that more cases will appear in the future. Therefore, a high index of suspicion seems to be important.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Morphine and other opiates and opioids can induce anaphylactic reactions via mast cell degranulation that continue to cause concern. IgE antibodies to morphine and codeine have been detected in the serum of at least one subject who experienced a life-threatening anaphylactic reaction following the administration of a combination of papaveretum and hyoscine.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> Indeed, Kounis syndrome has been also induced by morphine administration in two patients.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The described patient was fortunate when he received treatment with morphine, aspirin and ticagrelor for his constricting chest discomfort associated with dyspnea, sweating and hypotension and had an uneventful recovery. Fentanyl and its derivatives show little mast cell activation and are preferable.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0040" class="elsevierStylePara elsevierViewall">The described patient had coronary angiography, performed two hours after symptom onset, that excluded coronary disease. However, he had slightly raised high-sensitivity troponin levels with leukocytosis and neutrophilia during the anaphylactic event that denote type I variant Kounis syndrome attributed to coronary spasm. Indeed, leukocytes and polymorphonuclear neutrophils as well as other inflammatory markers have been found to be significantly associated with coronary artery spasm.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0045" class="elsevierStylePara elsevierViewall">We entirely agree with the authors of this report<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> that there is no consensus on treatment for Kounis syndrome, and most of the data on it are from case reports. However, a large group of eminent cardiologists, immunologists, allergists, anesthetists and surgeons have agreed to convene in order to establish diagnostic and treatment criteria, and we urge any scientist with interest and experience in this syndrome to participate.</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare cause of acute coronary syndrome: Kounis syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. 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Ano/Mês | Html | Total | |
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2024 Janeiro | 32 | 31 | 63 |
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2023 Outubro | 24 | 15 | 39 |
2023 Setembro | 30 | 22 | 52 |
2023 Agosto | 35 | 21 | 56 |
2023 Julho | 33 | 13 | 46 |
2023 Junho | 36 | 14 | 50 |
2023 Maio | 41 | 21 | 62 |
2023 Abril | 24 | 4 | 28 |
2023 Maro | 29 | 27 | 56 |
2023 Fevereiro | 32 | 20 | 52 |
2023 Janeiro | 16 | 12 | 28 |
2022 Dezembro | 42 | 22 | 64 |
2022 Novembro | 38 | 25 | 63 |
2022 Outubro | 51 | 20 | 71 |
2022 Setembro | 19 | 34 | 53 |
2022 Agosto | 28 | 38 | 66 |
2022 Julho | 33 | 38 | 71 |
2022 Junho | 32 | 20 | 52 |
2022 Maio | 29 | 37 | 66 |
2022 Abril | 28 | 32 | 60 |
2022 Maro | 32 | 36 | 68 |
2022 Fevereiro | 20 | 23 | 43 |
2022 Janeiro | 23 | 19 | 42 |
2021 Dezembro | 29 | 33 | 62 |
2021 Novembro | 24 | 41 | 65 |
2021 Outubro | 24 | 49 | 73 |
2021 Setembro | 24 | 26 | 50 |
2021 Agosto | 32 | 33 | 65 |
2021 Julho | 20 | 24 | 44 |
2021 Junho | 20 | 23 | 43 |
2021 Maio | 24 | 39 | 63 |
2021 Abril | 39 | 47 | 86 |
2021 Maro | 70 | 17 | 87 |
2021 Fevereiro | 65 | 20 | 85 |
2021 Janeiro | 37 | 16 | 53 |
2020 Dezembro | 31 | 9 | 40 |
2020 Novembro | 28 | 10 | 38 |
2020 Outubro | 18 | 14 | 32 |
2020 Setembro | 43 | 16 | 59 |
2020 Agosto | 24 | 8 | 32 |
2020 Julho | 43 | 12 | 55 |
2020 Junho | 32 | 19 | 51 |
2020 Maio | 27 | 3 | 30 |
2020 Abril | 38 | 9 | 47 |
2020 Maro | 38 | 20 | 58 |
2020 Fevereiro | 112 | 19 | 131 |
2020 Janeiro | 27 | 5 | 32 |
2019 Dezembro | 32 | 9 | 41 |
2019 Novembro | 23 | 10 | 33 |
2019 Outubro | 43 | 9 | 52 |
2019 Setembro | 35 | 9 | 44 |
2019 Agosto | 33 | 9 | 42 |
2019 Julho | 34 | 12 | 46 |
2019 Junho | 28 | 11 | 39 |
2019 Maio | 39 | 14 | 53 |
2019 Abril | 26 | 23 | 49 |
2019 Maro | 128 | 15 | 143 |
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2019 Janeiro | 71 | 6 | 77 |
2018 Dezembro | 83 | 15 | 98 |
2018 Novembro | 63 | 11 | 74 |
2018 Outubro | 107 | 18 | 125 |
2018 Setembro | 56 | 12 | 68 |
2018 Agosto | 32 | 15 | 47 |
2018 Julho | 13 | 7 | 20 |
2018 Junho | 32 | 6 | 38 |
2018 Maio | 40 | 9 | 49 |
2018 Abril | 48 | 11 | 59 |
2018 Maro | 63 | 16 | 79 |
2018 Fevereiro | 30 | 7 | 37 |
2018 Janeiro | 43 | 5 | 48 |
2017 Dezembro | 80 | 13 | 93 |
2017 Novembro | 62 | 20 | 82 |
2017 Outubro | 16 | 16 | 32 |
2017 Setembro | 27 | 25 | 52 |
2017 Agosto | 40 | 20 | 60 |
2017 Julho | 87 | 33 | 120 |
2017 Junho | 31 | 35 | 66 |