This is because it inhibits the release of histamine and other anaphylactic mediators, and it has strong stimulating effects on α- and β-receptors.[17] However, adrenaline may also exacerbates myocardial ischemia by further reducing coronary blood flow that is already impaired in Kounis syndrome due to factors such as coronary vasospasm, thrombus formation, and tachycardia.[1,8,18,19] Noradrenaline, vasopressin, and glucagon can be used in addition to adrenaline for treatment-resistant anaphylactic shock,[4,7,16] but there is no evidence to support their use in the absence of adrenaline. This evidence concerns the gene GCG and anaphylaxis.