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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Koniari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> for the interest demonstrated in our manuscript&#46; We have reported the case of an 85-year-old male who developed type 1 Kounis syndrome &#40;coronary spasm&#41; after administration of ciprofloxacin&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> The authors pointed out the potential role of the combined effect of the drugs the patient was taking &#40;hydroxyzine and alprazolam&#41;&#46; Indeed&#44; they cited case reports of cutaneous manifestations of allergy to hydroxyzine and alprazolam&#46; However&#44; our patient was chronically medicated with both drugs and never developed any manifestation of allergic reaction to them&#46; Therefore&#44; we think that a possible synergistic effect is less likely&#46; Also&#44; the temporal association with the intravenous administration of ciprofloxacin&#44; in a patient previously sensitized to quinolones&#44; is highly suggestive of reaction to that drug&#46; Nevertheless&#44; we think this concept is very interesting and we thank the authors for mentioning the possibility&#44; since clinicians should be aware that a mix of antigens can bring about an additive allergic reaction and even Kounis syndrome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The reference to the potential adverse effect that administration of morphine could have had in our case was also relevant and important&#46; True opioid allergies are rare and mediated by allergen-specific immunoglobulin E&#46; Morphine causes a greater histamine release than hydromorphone and fentanyl&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Therefore&#44; as stated by the authors&#44; in cases of suspected allergic reaction&#44; morphine should not be the first-line opioid&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; we think that Kounis syndrome is still an under-recognized entity and it is good to know that the medical community is gathering to standardize diagnostic and treatment criteria&#46; Our group is interested and available to be part of the relevant scientific committee&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Reply to the Letter to the Editor: “Quinolone-induced hypersensitivity reactions and the Kounis syndrome”
Resposta à Carta ao Editor «Reações de hipersensibilidade induzidas por quinolona e a síndrome de Kounis»
João Gonçalves Almeida
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Koniari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> for the interest demonstrated in our manuscript&#46; We have reported the case of an 85-year-old male who developed type 1 Kounis syndrome &#40;coronary spasm&#41; after administration of ciprofloxacin&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> The authors pointed out the potential role of the combined effect of the drugs the patient was taking &#40;hydroxyzine and alprazolam&#41;&#46; Indeed&#44; they cited case reports of cutaneous manifestations of allergy to hydroxyzine and alprazolam&#46; However&#44; our patient was chronically medicated with both drugs and never developed any manifestation of allergic reaction to them&#46; Therefore&#44; we think that a possible synergistic effect is less likely&#46; Also&#44; the temporal association with the intravenous administration of ciprofloxacin&#44; in a patient previously sensitized to quinolones&#44; is highly suggestive of reaction to that drug&#46; Nevertheless&#44; we think this concept is very interesting and we thank the authors for mentioning the possibility&#44; since clinicians should be aware that a mix of antigens can bring about an additive allergic reaction and even Kounis syndrome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The reference to the potential adverse effect that administration of morphine could have had in our case was also relevant and important&#46; True opioid allergies are rare and mediated by allergen-specific immunoglobulin E&#46; Morphine causes a greater histamine release than hydromorphone and fentanyl&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Therefore&#44; as stated by the authors&#44; in cases of suspected allergic reaction&#44; morphine should not be the first-line opioid&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; we think that Kounis syndrome is still an under-recognized entity and it is good to know that the medical community is gathering to standardize diagnostic and treatment criteria&#46; Our group is interested and available to be part of the relevant scientific committee&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 08702551
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