Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. We present a case of acute myocardial infarction associated with an allergic reaction in a 73-year-old Italian woman with recent implantation of stents. (C) 2008 Elsevier Ireland Ltd. All rights reserved.