LAUSR

[1] In 1991, Kounis and Zavras first proposed the concept To the Editor: A 42-year-old Chinese man presented with head trauma caused by a brief loss of consciousness and of anaphylactic angina and myocardial infarction, fell after a bee sting on his nasal root while cycling outdoors. After being rushed to the emergency room, he developed sweats, dizziness, headaches, bosom frowsty, shortness of breath, and urinary incontinence. Blood pressurewas 74/47 mmHg, blood oxygen saturation was 81%, and pulse rate was 149 beats/min. Physical examination revealed mental confusion, bilateral pupil diameter at 3 mm, slightly pupil insensitivity to light reflection, and rigid abdomen. 25 mg promethazineand10mgdexamethasonewere administered immediately. The patient had no previous history of cardiovascular disease or related risk factors. However, he had a history of bee stingswith no obvious abnormalities observed before. The electrocardiogram (ECG) showed sinus tachycardia (152 beats/min), ST-segment depression in II-III, and ST-segment elevation in aVR [Figure 1A]. Echocardiography and chest X-ray showed no abnormalities. Laboratory tests revealed the white blood cell count of 17.06 10/L (normal range: 3.5–9.5 10/L), eosinophil count of 0.73 10/L (normal range: 0.02–0.52 10/L), creatine kinase-MB (CK-MB) level of 29.5 ng/L (normal range: 0–5 ng/L), cardiac troponin I level of <0.5 ng/mL (normal range: 0–1 ng/mL), and myoglobin level of 249.1 ng/mL (normal range: 0–70 ng/mL); no other indicators showed obvious abnormalities. The patient underwent coronary angiography, but there were no significant abnormalities. A dermatologist performed specific immunoglobulin E (S-IgE) tests after consultation [Figure 1B], which revealed that S-IgE for tree combination (willow/ poplar/elm) was 11.4 kU/L (normal range: 0–0.35 kU/L). After anti-allergy medications were administered and fluid infusion, thepatient’s condition improved, and theECGand myocardial enzyme abnormalities were normalized. The doctor recommended the patient to avoid exposure to allergens.After follow-up for1 year, thepatient did not have any similar episodes.