The diagnosis of Kounis Syndrome is easily missed. It should be considered when certain clues are present.
Clues to the diagnosis:
(1) young age
(2) skin rash
(3) pruritus
(4) angioedema
(5) eosinophilia
(6) normal or nearly normal coronary angiography
(7) presentation: envenomation, drug exposure, allergic reaction, mastocytosis
The presence of eosinophils or mast cells in a coronary artery or coronary artery thrombus would be a clue but is rarely available.
