Kounis syndrome in poisoning due to bee stings, a narrative review

Kounis syndrome is defined by the appearance of acute coronary events associated to anaphylactic symptoms. The pathophysiological mechanism is still uncertain, however, coronary vasospastic activity secondary to a hy-persensitivity type I response is postulated as a triggering factor. In the con-text of an accident due to a massive bee’s attack, poisoning syndrome also occurs, where the poison components directly damage the myocardium. Kounis syndrome has been reported in SARS-CoV-2 infection, opening the possibility of other mechanisms, among which the cytokine storm stands out. This narrative review aims to consider the mechanisms of damage in Kounis syndrome secondary to poisoning by a massive bee attack and its relationship with the development of short-term complications.