Acute Coronary Syndrome Secondary to Type I Kounis Syndrome Following Suspected Wheat Hypersensitivity

Kounis syndrome (KS) is an acute coronary syndrome occurring in association with a hypersensitivity reaction. Type I variant is characterized by allergy-mediated coronary vasospasm in patients without pre-existing obstructive coronary artery disease. We describe a 31-year-old man who presented with diffuse pruritic urticaria after ingesting bread prepared from refined wheat flour. He had no conventional cardiovascular risk factors and reported previous cutaneous reactions to wheat consumption. During treatment of the allergic episode, he developed abrupt palpitations, diaphoresis, severe chest pain, tachycardia, and hypotension. Electrocardiography demonstrated ST-segment depression across leads V1-V6, and serum troponin I was elevated to 1.277 ng/mL. The ischemic electrocardiographic abnormalities resolved within one hour as his hemodynamic status improved. Echocardiography showed anterior wall hypokinesia with mild left ventricular systolic dysfunction and an ejection fraction of 50%. Coronary angiography performed 24 hours after symptom onset demonstrated normal epicardial coronary arteries without significant stenosis. The concurrence of a systemic allergic presentation, objective evidence of transient myocardial ischemia, and unobstructed coronary arteries supported the diagnosis of Type I Kounis syndrome. This case emphasizes the need to consider an allergy-mediated coronary event when acute myocardial ischemia occurs in a young patient with concomitant hypersensitivity manifestations and no established Coronary Artery Disease (CAD).