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The article describes the case of a 22-year-old woman who presented to the emergency department with complaints of palpitations and uneasiness of the chest after her first dose of COVID-19 vaccine. Topics covered include the medical history of the patient, the findings of the physical and laboratory examinations that led to the diagnosis of type 1 Kounis syndrome, and patient outcome following treatment.

In conclusion, clinicians should be aware of the wide spectrum of biochemical triggers, effectors, and pathogenic mechanisms capable of inducing fish-related KS to timely start the most appropriate diagnostic strategies and therapeutic approaches. In addition, several fish proteins have been encountered as other potential triggers of KS related to IgE-mediated hypersensitivity reaction because of their intrinsic allergenic properties. Letter to the Editor 370 Fish-related Kounis syndrome: One entity, multiple triggers To the Editor, Fish, shellfish, and seafood in general are often reported among the most active food inducers of Kounis syndrome (KS), although in the setting of fish poisoning, several molecular triggers and different pathogenic mechanisms may induce this clinical condition. [Extracted from the article]

The article presents a case study of a 53-year-old man who was admitted to emergency department due to tongue swelling and syncope following the consumption of fresh tuna fish and clams. Topics discussed he was afebrile and hypotensive, with normal cardiopulmonary results during physical examination; and the electrocardiogram (ECG) demonstrated a normofrequent sinus rhythm and 2 mm of ST elevation in inferior leads and ST depression in aVL and V2–V3.

The article reports that anaphylactic cardiogenic shock is a complex and extremely dangerous complication of anaphylaxis, which involves complex patho-physiological mechanisms. It refers to a case study involving a 44-year-old male patient, who developed Kounis syndrome and cardiogenic shock following the intravenous administration of ampicillin or sulbactam. The patient had an uneventful recovery, with the initiation of prednisolone, diphenhydramine, and intracoronary nitroglycerin treatment.