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Kounis syndrome is a condition where inflammatory cells (mostly mast cells with the contribution of macrophages and T-lymphocytes) cause an acute coronary syndrome. Kounis syndrome comes in four variants: type I in patients with normal coronary arteries; type II in patients with inactive pre-existing atheromatous disease; type III in patients with pre-existing coronary artery stenting; type IV in patients with a pre-existing coronary artery bypass. Recently, we came across a case of recurrent type I Kounis syndrome in our clinical practice. The purpose of the paper is to present our case and conduct a review using the Pubmed scientific database about the most relevant cases of recurrent Kounis syndrome. This review shows that recurrent Kounis syndrome is a rare condition and is mostly associated with Kounis syndrome type III. Recurrent Kounis syndrome may be also triggered by vaccination and it could be associated with chronic spontaneous urticaria. In the last condition, therapy is represented by second-generation anti-histamines and corticosteroids, but also by an anti-IgE monoclonal antibody (omalizumab) in the recalcitrant cases.

Compliance with vaccination is linked to its safety. In Italy, a plan to identify people who could be at an increased risk of adverse events (AEs) was defined so they could be vaccinated in a protected setting. We conducted an audit to describe the process of AE risk assessment and occurrence in the Reggio Emilia Province in Italy in people who received any of the four COVID-19 vaccines currently used in Italy. Incidence of AEs was calculated by dose and type of vaccine and type of setting (standard vs. protected). After 182,056 first doses were administered, 521 (0.3%) AEs were reported. Most of the AEs were non-serious (91.4%) and non-allergic (92.7%). The percentage of AEs was similar in both settings: 0.3% in the standard setting and 0.2% in the protected setting. However, the incidence of AEs was higher among those who had an allergist visit than among those who did not (IR 666.7 vs. 124.9). All deaths (1.6/100.000) occurred in standard settings and after the Pfizer and Moderna vaccines. The incidence of AEs was lower after the second dose (IR 286.2 vs. 190.3), except for mRNA vaccines, for which it was higher after the second dose (IR 169.8 vs. 251.8). Although vaccination in a protected medical setting could reassure patients with a history of allergies to be vaccinated, allergy history and other anamnestic information is not useful in predicting the risk of COVID-19 vaccine-related AEs in the general population.

Introduction . The poor long-term adherence is known to affect the efficacy of allergen immunotherapy (AIT). In the case of injection AIT (SCIT), one of the main determinants is the inconvenience for patients to undergo prolonged build-up phases. Thus, simplifying the time schedule of the induction protocol could be effective in increasing the adherence to SCIT., Methods: We backtracked the SCIT renewal orders, thanks to the cooperation of the manufacturing company, and we compared the long-term adherence of 152 patients, who were prescribed with an abbreviated build-up schedule (4 injections, allergoid) with that of 302 patients treated with the same product, but with the traditional build-up protocol (7 injections)., Results: According to the patient-named refills, those patients on the abbreviated build-up were significantly more compliant at the 2nd and 3rd year of treatment compared to the other group ( p =0.0001). The drop-out rate after one year was also significantly lower between the two groups ( p =0.0001). The drop-out rate after one year was also significantly lower between the two groups ( p =0.0001). The drop-out rate after one year was also significantly lower between the two groups (., Conclusions: Abbreviating the build-up phase by reducing the number of injections significantly improves patients' adherence to SCIT., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Cristiano Caruso et al.)