This blog is a way of sharing the information and resources that have helped me to recover my son Roo from an Autism Spectrum Disorder. What I have learned is to view our symptoms as the results of underlying biological cause, which can be identified and healed. I say "our symptoms" because I also have a neuro-immune disorder called Myalgic Encephalomyelitis.

And, of course, I am not a doctor (although I have been known to impersonate one while doing imaginative play with my son)- this is just our story and information that has been helpful or interesting to us. I hope it is helpful and interesting to you!

Wednesday, May 31, 2017

Meditation, Mindfulness, and Breath Work

There has been more and more awareness of the damage that chronic stress can do to our bodies, even having epigenetic effects.  Chronic stress in childhood is especially toxic but the chronic stress that the parents of many special needs kids, especially children with autism and/or serious health conditions experience, is also very harmful.  Then on top of all of that there is the added stress of dealing with medical insurance companies, doctor's offices, the intense financial demands that chronic health issues place on a family, and the school system if you choose to send your child to school.  Having as many tools as possible to help us calm our anxiety, sleep better, stay more focused and present, and to minimize the effects of an intrinsically stressful life, becomes a necessity.  Since I am homebound, what works for me the best are guided visualizations and meditations.  There are so many different approaches and styles, so I am including a few of the shorter ones here as a sort-of sample pack so that you can try some different approaches.  I have also found that some of these guided meditations are truly wonderful in helping me fall asleep.

Adorable Animated Mice Explain Meditation in 2 Minutes

Why Mindfulness Is a Superpower: An Animation

Mindfulness Guided Meditation - 5 Minutes

How to Meditate - 5 Minute Meditation Escape (this video demonstrates a particular method)


Before Sleep | Beginners Spoken Guided Meditation | Chakra Alignment |How to Chakra Balance

Activating the hand chakras

The Science Of Yogic Breathing | Sundar Balasubramanian

The speaker found that after practicing yogic breathing regularly, he began to produce more saliva.  Not only would this be helpful for people with chronic dry mouth, but also saliva has many different contents in addition to being a digestive fluid.  It also has hormones, proteins, growth factors, including nerve growth factor.  Nerve Growth Factor not only helps nerve cells to grow but it is protective of nerve cells and helps them live longer.  Levels of nerve growth factor are significantly reduced in people with Alzheimer's.  Nerve Growth Factor is given therapeutically to patients with Alzheimer's so he did a clinical trial which showed that yogic breathing does raise levels of nerve growth factor.  They also found other proteins and hormones that are involved in coping with stress and pain, cancer, immune function, and other things.  There is a saying when talking about meditation that the mind is a monkey- but not just a normal, a drunken monkey who has been stung by a scorpion.  Because of this trying to control the mind is very hard.  Instead, we can focus on controlling our breath, which then helps to tame the money.

Breath -- five minutes can change your life | Stacey Schuerman

Sunday, May 21, 2017

Physical and Manual Therapies

We've found, as many biomed families have, that physical and touch-based therapies are an essential part of healing and can make a profound difference in the day-to-day quality of life of a person.  The better known therapies and techniques include physical therapy, occupational therapy, chiropractic, and yoga.  Each is somewhat different and better suited to some people more than others.  There are so many different methods and with some research and trial-and-error it seems that many people find at least one method that helps significantly.  I am including links below to the various therapies that I'm familiar with, but first a little inspiration and reminder about possibilities:

This beautiful and flexible dance is performed by a woman who fell 40 feet while mountain climbing and was told that she would never walk again, let alone dance.  I don't know what she did as far as treatment (but I will try to find out!) because her healing and abilities now are absolutely amazing.

Real Bodywork
This is a site that has a lot of resources for many different treatment modalities including how-to videos, posters, articles, apps, etc.

Myofascial Release
"Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.  Trauma, inflammatory responses, and/or surgical procedures create Myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, lectromyography, etc.)"

CranioSacral Therapy
"CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system."

Lymphatic Drainage
"Lymphatic drainage massage is a profound technique to help increase lymph flow. With an increase of lymph flow immune function is increased. Harmful substances are removed from the tissues and neutralized in the nodes. It has also been shown that an increase in lymph flow stimulates an increased production of lymphocytes- enhancing immune function."
     Lymph Drainage for Detoxification
     How to do Self-Lymphatic Drainage to help manage lymphedema

Strain/Counterstrain (also called Positional Release)

Bendable Body


     “She will dance at her wedding”: Healing the girl born without part of her brain

Kinesthetic Storytelling (and the healing power of light touch)
     This is a TED talk called "The Curative Touch of a Magic Rainbow Hug"

Qi Gong and Qi Gong Massage

Mayan Abdominal Massage
"The Arvigo® techniques were developed by Dr. Rosita Arvigo, DN. based on her apprenticeship with the Maya healer Don Elijio Panti and her own education, training, and research as a naprapathic physician. Rosita's lifework, THE ARVIGO TECHNIQUES OF MAYA ABDOMINAL THERAPY®, help to restore the body to its natural balance by correcting the position of organs that have shifted and restrict the flow of blood, lymph, nerve and chi energy. Today the Arvigo® techniques are employed by Arvigo® Practitioners across the globe bringing the benefits of natural healing to their clients."

Dystonia. Rewiring the brain through movement and dance | Federico Bitti | TEDxNapoli
I don't know if this type of therapy has a name, but it is a movement-based approach to treat the spastic movements, pain, cramping, tremors, and frozen muscles that are the hallmark of various movement disorders such as Dystonia. In the case of the speaker at least, it gave him control of his body back and freedom from pain.  This is the presentation given by the man who developed this approach: How your movements can heal your brain | Joaquin Farias | TEDxNapoli

Brain Therapy This is supposedly a further use and development of lymphatic drainage similar to CranioSacral Therapy; however it claims to actually work on the membranes inside the head (such as the Dura mater and Pia Mater) as well as the brain itself.  Honestly, I have no idea how this would work, but it is a very intriguing.

Friday, May 19, 2017

Living With And Overcoming Brain and Neurological Injury

My Beautiful Broken Brain
This video documentary was made by a young woman who suffered a massive stroke, and chronicles her experiences, therapies, and progress in trying to recover as much as she can.  It also provides a powerful window into what life is like for her after the stroke and how it has affected how she sees the world and how she functions in it.

The Real Sleeping Beauty (Medical Miracle Documentary) - Real Stories
This is the story of a woman who came out of a coma after 20 years and began to speak again.  This is almost unheard of and it's not clear why she was able to do it, but it does offer hope that there are more possibilities for healing from brain injury than had previously been thought.

Empowering the Mind to Heal the Brain for Stroke | Dr. Eric C. Leuthardt 
This man gives a talk describing a therapeutic device that he created to help people who have lost some motor function due to a stroke.  It helps the brain learn a new way to control motor movement that has been lost.  This is a new technology that has not been thoroughly studied yet, but so far the results are impressive and people using the device have regained abilities that doctors have considered not possible.

Dystonia. Rewiring the brain through movement and dance | Federico Bitti
This man tells us what developing Dystonia, a neurological movement disorder, felt like and how life limiting it was.  He tried several of the conventional treatments but the disorder continued to worsen.  He did not want to undergo the very invasive brain surgery that was his only option, according to his specialist.  Instead he found someone who was developing a treatment modality based in neuroplasticity- retraining the brain with a customized program of exercises and movements that gave Mr. Bitti back much of the control over his body so that he regained many of the abilities that he had lost.  He then accidentally stumbled onto another way to overcome the remaining symptoms; he discovered that dancing was for him a very powerful way to work with his body and continue to heal.  What it also gave him back was a way to enjoy being in his body again.  For people who lose basic motor function, the experience of physicality- of being in your body- can become so unpleasant, it can feel like fighting a losing battle, and it cannot be emphasized enough how much this affects quality of life.  Finding ways to work with your body and to enjoy movement again can make a profound difference.  As Mr. Bitti says, it can be a way to find your bit of paradise inside of the hell of the movement disorder.

Saturday, March 18, 2017

D.I.Y. Home Remedies

Making our own versions of commercial products such as personal care products, cleaning products, and OTC medications and treatments is one way to significantly lower our exposure to the harmful ingredients that are commonly in the commercial versions of these products.  Homemade products are often less expensive and may also provide more options for addressing our health needs.



Baking soda and vinegar can be used as shampoo and conditioner.

How to make your own lipstick

How to make bug repellent

How to make rose oil (or other flower oil)

How to make your own deodorant

How to make sunscreen

This is a recipe to make herbal lip balm

How to make your own hairspray


A piece of aluminum foil can replace a dryer sheet for stopping static cling.


Recipe for homemade electrolyte drink

How to make calcium supplements from eggshells

How to make your own Vick's-style vapor rub
(For more on the harmful effects of Vick's VapoRub and why you would want to make your own, read this article)


Using honey and mead to treat infections

Probiotics can be used to fight a sinus infection

This post describes how one person used ACV (apple cider vinegar) to remove a mole

This tonic made from garlic, raw honey and ACV is a general immune booster


How to use ear candles

Vaginal steaming to support the female reproductive system


This post has a link that shows you how to make a HEPA air filter out of inexpensive parts available at the hardware store.

NASA guide to plants that clean the air

15 House Plants You Can Use As Air Purifiers

Smudging eliminates harmful bacteria from indoor spaces

Thursday, March 9, 2017

The Movie Shelf

This is a collection of documentary movies and films (that are available online) and relevant to the topics discussed in this blog.


King Corn

Supersize Me

Food, Inc


Autism Yesterday is a short film about kids recovering from autism with biomed treatments.

Autism - Made in the U S A by Gary Null

Wretches and Jabberers

Temple Grandin


My Kid is Not Crazy (this is a film being made about PANDAS/PANS)

Unstuck- An OCD Kids' Movie


Making Rounds: Medical Education Film.  This is an excellent presentation of what it looks like when very skilled and compassionate doctors go on rounds- how they ask questions to quickly discover relevant medical history, and how they use keen observation of the patients to find clues as to what might be the problem.

Off Label



VAXXED: From Cover Up to Catastrophe

The Greater Good

Shots In The Dark: Silence on Vaccines

The Hidden Truth (Australian movie)

Direct Order (about soldiers forced to take the Anthrax vaccine and were injured by it)

Vaccine Nation

Silent Epidemic; The Untold Story of Vaccines



The Human Experiment

The Poisoner's Bible is an episode of the PBS show American Experience.  From the site:
"In the early 20th century, the average American medicine cabinet was a would-be poisoner's treasure chest, with radioactive radium, thallium, and morphine in everyday products. The pace of industrial innovation increased, but the scientific knowledge to detect and prevent crimes committed with these materials lagged behind until 1918. New York City's first scientifically trained medical examiner, Charles Norris, and his chief toxicologist, Alexander Gettler, turned forensic chemistry into a formidable science and set the standards for the rest of the country."
This show is very relevant to anyone interested in toxic exposures and the health effects that can result, as well as some of the history of government involvement (or lack of involvement) in regulating toxins and our exposure to them.

The Disappearing Male “The Disappearing Male is about one of the most important, and least publicized, issues facing the human species: the toxic threat to the male reproductive system. The last few decades have seen steady and dramatic increases in the incidence of boys and young men suffering from genital deformities, low sperm count, sperm abnormalities and testicular cancer. At the same time, boys are now far more at risk of suffering from ADHD, autism, Tourette's syndrome, cerebral palsy, and dyslexia.

The Disappearing Male takes a close and disturbing look at what many doctors and researchers now suspect are responsible for many of these problems: a class of common chemicals that are ubiquitous in our world. Found in everything from shampoo, sunglasses, meat and dairy products, carpet, cosmetics and baby bottles, they are called "hormone mimicking" or "endocrine disrupting" chemicals and they may be starting to damage the most basic building blocks of human development.“


My Beautiful Broken Brain is a film about a young woman working to recover from a severe stroke. It is currently available on Netflix.

Issues With My Tissues is about a woman with Vascular EDS as she works to reach her goal of walking the entire London Marathon.  It's a good window into daily life with EDS.


Dying to Have Known (film about Gerson Therapy)

The Beautiful Truth (also about Gerson Therapy)


Class Dismissed is a film about homeschooling.

The War on Kids




Psychedelics as Mental Health Treatment

Mental health is an area of western medicine where there still aren't many treatment options, and many people are helped only somewhat or not at all by what's available.  Recently research into the use of psychedelic drugs for legitimate therapeutic purposes has started up again after being more or less abandoned during the 60s and 70s.  Below is a TED talk about the use of LSD and psilocybin to treat Treatment-Resistant Depression and PTSD.  So far both drugs are showing promise which is  exciting because in the cases of both PTSD and Depression, many patients don't

From the article "Could a Club Drug Be the Secret to Curing PTSD?" that has just appeared in the March issue of Elle magazine:

"Ever since Richard Nixon signed the Controlled Substances Act in 1970, prohibiting the use of almost all psychedelics for any purpose, most scientists have regarded consciousness-altering drugs warily, if they thought about them at all. But as the war on drugs wanes and failures of U.S. drug policy become increasingly clear (witness the opioid epidemic), scientists are revisiting research on psychedelics. There are the studies of MDMA for PTSD, and scientists have also begun exploring the drug's potential to treat addiction, depression, and severe anxiety in adults with autism. Other psychedelics are also yielding promising lab results, including psilocybin (the active ingredient in so-called magic mushrooms), which teams of researchers from Johns Hopkins and New York University found can reduce anxiety and depression in cancer patients."

"Before Ecstasy became famous in the 1990s as the street drug of choice among ravers and curious college kids, a loosely knit network of psychiatrists and psychologists experimented with giving patients medical-grade MDMA, a synthetic compound originally developed by a Merck chemist in the early 1900s, to treat anxiety and depression."

"So far, 77 percent of the participants who have received MDMA in the Boulder pilot no longer meet the diagnostic criteria for PTSD, according to Marcela Ot'alora, the study's lead investigator. After another clinical trial in Charleston, South Carolina, a similar effect was seen in 83 percent of the group that received MDMA treatment (compared to just 25 percent of the group who received talk therapy alone). Perhaps most encouragingly, three and a half years after the Charleston study was completed, the benefits largely held: Three-quarters of the MDMA-treated patients who'd been deemed clinically free of PTSD remained free of it,"

Friday, March 3, 2017

Kounis Syndrome (Allergic Heart Attack)

The correlation between allergic reactions and cardiac symptoms was first officially noted in 1950 during an allergic reaction to penicillin.  Since then, this correlation has been noted at other times, but it wasn't until 1991 when Dr Kounis brought attention to the phenomenon that it started getting more recognition.  Kounis Syndrome (KS) refers to the situation in which an allergic reaction progresses to involve significant cardiac distress that can be an actual heart attack (Myocardial Infarction) or a spasming of the coronary artery that is very similar to a heart attack   Sometimes the chest pain associated with allergic reactions is called Allergic Angina.

The majority of Kounis Syndrome cases occur in Spain, Italy, Greece, and Turkey.  In these areas Kounis Syndrome is seen in about 1 in 5 coronary events.  It seems likely that this reflects a much more widespread awareness of this disorder in these countries, so it seems likely that the rate of Kounis Syndrome in the US is probably much higher than currently thought.  Without recognition of
the relationship between allergic reactions and coronary symptoms, people prone to Kounis Syndrome will continue to have these dangerous attacks until their allergic problems are managed better. KS has been documented in both children and adults.

Medscape explains a Kounis Syndrome episode in more detail:
"The pathophysiologic characteristics of KS involve coronary artery spasm and/or atheromatous plaque erosion or rupture during an allergic reaction. Coronary spasm is the result of local
hyperreactivity of a coronary segment to a vasoconstrictor stimulus.[1] The exact mechanisms resulting in vasospastic angina have not been fully established. It has been postulated that endothelial injury and hypercontractility of vascular smooth muscle may be the result of vasoconstrictor mitogens, leukotrienes, serotonin, endothelin, angiotensin II, histamine, and higher local concentration of blood-borne vasoconstrictors in areas adjacent to neovascularized atherosclerotic plaque.[15]"

There are 3 types of Kounis Syndrome:
-the first type is when the patient does not have existing coronary artery disease, but the mediators released during a mast cell reaction induce spasms in the coronary artery.  This can feel and look like a heart attack but does not always leave behind traces of evidence such as elevated enzyme levels.
-in the second type there is pre-existing atherosclerosis, which can be loosened and freed by the coronary spasms and this can then cause an actual Myocardial Infraction.
-in the third type, the person has a stent and the stent becomes occluded due to inflammation from histamine.  Since most stent-associated occlusions occur soon after they are placed, suspect this if the occlusion occurs long after the stent is placed.

Medscape provides more detail about the first two types:
Type 1 "is the occurrence of chest pain during an acute allergic reaction in patients without predisposing factors for coronary artery disease. An acute allergic event induces coronary artery spasm, resulting in chest pain and ischemic electrocardiographic changes, and the cardiac enzymes can either be normal or reflect progression to an acute myocardial infarction.[6,11] These cases have a normal myocardial perfusion scan, normal coronary angiogram, and positive ergonovine test.[11] The explanation for this type would be endothelial dysfunction or microvascular angina.[12]"

Type 2 "is the occurrence of chest pain in patients with angiographic evidence of coronary artery disease during an acute allergic reaction.[6,11] This type includes patients with quiescent pre-existing atheromatous disease, in whom an acute allergic episode can induce plaque erosion or rupture manifesting as an acute myocardial infarction.[1,6,12]"

More from Medscape "Histamine not only constricts the coronary arteries, but also sensitizes the nerve endings adjacent to adventitial mast cells in atherosclerotic coronary arteries.[20] Cardiac histamine acts via four different histamine receptors, and each receptor can contribute to the severity of the allergic myocardial damage. The H1 receptor mediates coronary vasoconstriction, while the H2 receptor mediates a minor degree of coronary relaxation. The interaction between H1 and H2 causes a decrease in diastolic blood pressure and an increased pulse pressure. H3 inhibits the endogenous norepinephrine release (enhancing the degree of shock observed during allergic reactions), and finally the H4 receptor regulates the chemotaxis of mast cells, eosinophils, and lymphocytes, causing change in the shape of eosinophils and upregulating adhesion molecules.[6,13,20]"

"Not all patients suffering from an allergic reaction develop an acute coronary event. What determines the development of KS remains unclear; however, it has been suggested that there is a threshold level of mast cell activation and mediator release above which the coronary artery spasm and plaque erosion or rupture occurs. This threshold level would be closely linked to the body site where the antibody-antigen reaction occurs, the area of exposure, mediator release, and, of course, the severity of the allergic reaction.[19,23]"

Detecting and Diagnosing Kounis Syndrome

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management
"Recent research has shown that Kounis-like syndromes can affect the mesenteric and cerebral arteries. The coronary arteries, the heart and the entire arterial system seem to be vulnerable to allergic, hypersensitivity, anaphylactic, and/or anaphylactoid events and physicians should be alert for its consequences."

"The diagnosis of Kounis syndrome is based on clinical symptoms and signs as well as on laboratory, electrocardiographic, echocardiographic and angiographic evidence. A variety of these findings might accompany allergic symptomatology that helps in putting the correct diagnosis. Recently, modern tools such as cardiac magnetic resonance imaging and myocardial scintigraphy have helped to confirm the diagnosis. A high index of suspicion is of paramount importance. Therefore, patients with systemic allergic reactions associated with clinical, electrocardiographic and laboratory findings of acute myocardial ischemia should be suspected as having Kounis syndrome."

In patients with type I variant, treatment of the allergic event alone can abolish symptoms. The use of intravenous corticosteroids such as hydrocortisone at a dose of 1–2 mg/kg/day and H1 and H2 antihistamines such as diphenhydramine at a dose of 1–2 mg/kg and ranitidine at a dose of 1 mg/kg are adequate. The administration of vasodilators such as calcium channel blockers and nitrates can abolish hypersensitivity induced vasospasm. Calcium channel blockers can induce minor skin rash and angioedema is extremely uncommon. However, nitroglycerin can causes hypotension and tachycardia that may further complicate anaphylactic reaction. In addition, although uncommon, allergic reactions to nitroglycerin such as urticaria and contact dermatitis can occur especially with the transdermal use of nitroglycerin. Most patients with these reactions have tolerated oral and sublingual nitroglycerin. Therefore, the use of intravenous or sublingual nitroglycerin seems reasonable and safe in patients with Kounis syndrome if the blood pressure is satisfactory. Bolus administration of antihistamines can precipitate hypotension and compromise coronary flow; therefore, these drugs should be given slowly."

"In patients with type II variant, treatment should be initiated with an acute coronary event protocol together with corticosteroids and antihistamines. Vasodilators such as nitrates and calcium blockers are given when these are necessary. The use of b-blockers can exaggerate coronary spasm due to unopposed action of a-adrenergic receptors. Epinephrine which is the drug of choice and can save lives in anaphylaxis, but in Kounis syndrome can aggravate ischemia and worsen coronary vasospasm. In severe cases sulfite free epinephrine is preferable to be given intramuscularly because it has faster onset of action and more sustained levels as compared with the subcutaneous route (recommended intramuscular doses 0.2–0.5 mg [1:1000]). Aqueous solution is preferable. In patients with previous history of coronary heart disease, who receive b-blockers, epinephrine may be ineffective. It may also induce more vasospasm due to unopposed a-adrenergic effect. In this case glucagon infusion (1–5 mg, intravenously over 5 min, followed by infusion 5–15 μg/min) can be used for patients who are already on beta-blockers or received them during the management of the acute coronary syndrome. Methoxamine, a potent alpha agonist, can also be considered in patients who do not respond to epinephrine. Opiates such as morphine, codeine and meperidine given to relieve acute chest pain should be administered with extreme caution in patients with Kounis syndrome, since they can induce massive mast cell degranulation and aggravate allergic reaction. Acetaminophen (paracetamol) is not recommended, especially its intravenous administration, because it might cause severe hypotension due to reduction of cardiac output. Fentanyl and its derivatives show slight mast cell activation and are preferable."

The utility of cardiac magnetic resonance imaging in Kounis syndrome.
"Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1."

Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels?
"These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS."

Prevention and Treatment

As with any mast cell disease, identifying and avoiding triggers is essential, but this may not be easy since there are so many things that can trigger a Kounis Syndrome episode.

Coronary Hypersensitivity Disorder: The Kounis Syndrome
This article has a relatively long section about treatment for each type of Kounis Syndrome.

Stress triggers coronary mast cells leading to cardiac events.
"Stress can precipitate allergies and ACS. Stress stimulates MCs through the activation of high-affinity surface receptors for CRH, leading to a CRH-dependent increase in serum IL-6. Moreover, neurotensin secreted with CRH from peripheral nerves augments the effect of CRH and stimulates cardiac MCs to release IL-6, which is elevated in ACS and is an independent risk factor for myocardial ischemia. MCs also secrete CRH and uroctortin, which induces IL-6 release from cardiomyocytes. The presence of atherosclerosis increases the risk of cardiac MC activation owing to the stimulatory effect of lipoproteins and adipocytokines. Conditions such as Kounis syndrome, mastocytosis, and myalgic encephalopathy/chronic fatigue syndrome are particularly prone to coronary hypersensitivity reactions. Inhibition of cardiac MCs may be a novel treatment approach."

Drugs that may provoke Kounis Syndrome
"KS has been increasingly reported in the literature and has been linked with several conditions, environmental exposures and a variety of drugs, leading many experts to believe that KS is not rare, only "rarely diagnosed". Also:

"Treatment may be challenging because it needs to consider both cardiac and allergic symptoms simultaneously, and the drugs administered for these manifestations can aggravate an allergic reaction and heart function. Cevik et al. have summarized recommendations concerning the treatment of KS from available data, since most information about KS comes from case reports. The authors argue that:

1) Aspirin has the potential risk of aggravating an ongoing anaphylactic reaction since it might shunt arachidonic acid into the leukotriene pathway with overproduction of leukotrienes. Therefore, the utility of aspirin in patients with KS is unknown.

2) Nitroglycerin causes hypotension and tachycardia, which may further complicate anaphylactic reaction, but seems safe in KS if blood pressure is satisfactory.

3) Beta-blockers may induce more vasospasm due to unopposed α-adrenergic effect and may offset some of the beneficial effects of epinephrine.

4) Coronary spasm is very responsive to calcium channel blockers, so they may be considered the initial anti-ischemic drug of choice in patients with KS.

5) Morphine and meperidine should be used cautiously since these opiates can induce mast cell degranulation and aggravate the allergic reaction. Fentanyl and its derivatives show only a slight activation of mast cells and may be the drugs of choice when narcotic analgesia is necessary.

6) Corticosteroids have a major role in the treatment of allergic reactions, and may prevent recurrent or protracted anaphylaxis. A meta-analysis of the studies of corticosteroid treatment in acute MI reported no harm and possible mortality benefit with these drugs in this setting. Therefore, their use is probably safe and appropriate.

7) Epinephrine is the drug of choice in anaphylaxis, but in KS the risks may outweigh the benefits. Epinephrine can aggravate the ischemia as well as induce coronary vasospasm and arrhythmias. The majority of epinephrine preparations contain sulfite which itself may trigger anaphylaxis in sensitive individuals. It may also promote more vasospasm secondary to unopposed alpha-adrenergic effect in patients who have received beta-blocking agents. More case studies are needed to establish the appropriate use of epinephrine in patients with KS.

8) Mast cell membrane stabilizers may be considered in KS."

The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes.
"Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients."

Kounis Syndrome (MedScape)

Kounis syndrome; South Med J. 2010 Nov;103(11):1148-55.

Current understanding of Kounis syndrome
"Inflammatory mediators, adhesion molecules of neutrophils and monocytes, have been shown to be increased in the plasma of patients presenting with acute coronary syndromes. Anaphylaxis is a systemic, immediate hypersensitivity reaction caused by rapid IgE-mediated release of mediators from mast cells and basophils. Kounis syndrome is the coincidental occurrence of these two distinct conditions accompanied by clinical and laboratory findings of angina pectoris caused by inflammatory mediators released during an allergic insult. Allergic angina can progress to acute myocardial infarction, which is termed 'allergic myocardial infarction'. There are several causes reported to be capable of inducing Kounis syndrome. These include a number of conditions, several drugs, foods and insect stings, among others. In this article, the clinical aspects, diagnosis, pathogenesis, incidence and epidemiology, related conditions and therapeutic management of this important syndrome are discussed."

"We present three cases of anaphylactic acute coronary syndrome that display different clinical variants of this phenomenon. The main pathophysiological mechanism of the allergic anginal syndromes is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites, or drugs. It is important to appropriately recognize and treat Kounis syndrome in patients with exposure to a documented allergen."