Underdiagnosis and pharmacovigilance. The case of allergic acute coronary syndrome (Kounis syndrome)

摘要

We read with great interest the manuscript by Ilhan E et al. [1] reporting the case of a 16 year-old child who developed a misdiagnosed Kounis syndrome (KS) induced by amoxicillin/clavulanic acid. The authors stated that KS is increasingly encountered in clinical practice and, as many experts currently do, they believe that KS is not an uncommon disease, but rather an under-diagnosed disease [2,3]. We strongly agree with this assumption and, as a Regional Centre of Pharmacovigilance, we would like to highlight the role of Pharmacovigilance Intensive Monitoring in the detection of under-diagnosed adverse drug reactions (ADR), including KS. In particular, in the frame of an intensive ADR monitoring project activated in Tuscan County Emergency Departments, we encountered between December 2011 and February 2012, three cases of patients in a single hospital (Prato, Italy) who were diagnosed with unstable angina or acute myocardial infarction - according to analytical parameters, electrocardiographic abnormalities, and/or coronary angiography - in the context of an anaphylactic episode, after taking one or more pills of amoxicillin or amoxicillin/clavulanic acid.