Kounis Syndrome and Vanadium allergy: heed your hunch

The case of a 52-year-old man with a medical history of diabetes mellitus, dyslipidemia, and chronic ischemic heart disease with several episodes of acute coronary syndrome is presented. Patch tests were performed with the baseline series recommended by the European Contact Dermatitis Society (ECDS). Patch testing with vanadium (III) chloride 1% in 5 asymptomatic controls with the Onyx stent elicited no reaction. The patient was reinterviewed on previous exposure to metals and referred childhood contact with chrome-vanadium car hand-tools in his father's workshop, without symptoms. The patient had a positive reading at all concentrations of vanadium (III) chloride and a negative reading with the remaining allergens. LTT in 5 controls with the Onyx stent showed no response to any component.