Methods. A systematic review of recorded cases of allergic vasospastic angina from 1992 to 2022 was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Then, each case report was analyzed in terms of the patient’s characteristics, the presented signs/symptoms, and the results of cardiac and allergic tests.
Results.A systematic review of 193 cases of allergic vasospastic angina showed an average age of 53 years (64% were men); 46% had one or more risk factors for cardiovascular diseases, and 32% had a history of atopy.Most patients experienced acute coronary syndrome (myocardial infarction with ST‑segment elevation in 71%) after exposure to a wide range of triggering allergens (55% were prescription medications), with multiple potential allergic mechanisms, including immunoglobulin E (IgE)‑mediated degranulation of mast cells, eosinophil‑mediated allergic reactions, and other non‑IgE‑mediated pathways of mast cell activation.
Conclusion. Allergic vasospastic angina is an important and understudied subtype of vasospastic angina, often manifesting as an acute coronary syndrome. Diagnosing this disease is important because the treatment differs from that of typical vasospastic angina and may include avoiding allergens and using medications that modulate the allergic reaction.
https://doi.org/10.1136/heartjnl-2025-326599
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