Skip to main content Accessibility help

A case of Kounis syndrome associated with branched-chain amino acid supplementation in a 17-year-old boy

  • Volkan Dogan (a1)


Kounis Syndrome is characterised by the concurrence of acute coronary syndrome with mast cell activation induced by inflammatory mediators released during an allergic reaction. Although several factors and diseases were reported to be associated with Kounis Syndrome, branched-chain amino acid supplements have not been previously reported as a cause of Kounis Syndrome. We present a 17-year-old boy admitted to our hospital with thoracic pain after the ingestion of a branched-chain amino acid supplement.


Corresponding author

Author for correspondence: V. Dogan, MD, Assistant Professor, Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey. Tel: +90 252 212 75 28; Fax: +90 252 212 75 29; E-mail:


Hide All
1. Biteker, M. Current understanding of Kounis syndrome. Expert Rev Clin Immunol 2010; 6: 777788.
2. Ruiz-Canela, M, Toledo, E, Clish, CB, et al. Plasma branched-chain amino acids and incident cardiovascular disease in the PREDIMED Trial. Clin Chem. 2016; 62: 582592.
3. Shah, SH, Bain, JR, Muehlbauer, MJ, et al. Association of a peripheral blood metabolic profile with coronary artery disease and risk of subsequent cardiovascular events. Circ Cardiovasc Genet 2010; 3: 207214.
4. Bhattacharya, S, Granger, CB, Craig, D, et al. Validation of the association between a branched chain amino acid metabolite profile and extremes of coronary artery disease in patients referred for cardiac catheterization. Atherosclerosis 2014; 232: 191196.
5. Magnusson, M, Lewis, GD, Ericson, U, et al. A diabetes-predictive amino acid score and future cardiovascular disease. Eur Heart J 2013; 34: 19821989.
6. Biteker, M, Biteker, FS, Özlek, B, et al. Classification of Kounis syndrome. Int J Cardiol 2017; 247: 13.
7. Schwartz, LB, Metcalfe, DD, Miller, JS, Earl, H, Sullivan, T. Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis. N Engl J Med 1987; 316: 16221626.
8. Grasser, EK, Miles-Chan, JL, Charrière, N, Loonam, CR, Dulloo, AG, Montani, JP. Energy drinks and their impact on the cardiovascular system: potential mechanisms. Adv Nutr 2016; 7: 950960.
9. Mangi, MA, Rehman, H, Rafique, M, Illovsky, M. Energy drinks and the risk of cardiovascular disease: a review of current literature. Cureus 2017; 9: e1322.


A case of Kounis syndrome associated with branched-chain amino acid supplementation in a 17-year-old boy

  • Volkan Dogan (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed