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Anaphylaxis — MRCPCH FOP MCQ

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EasyEmergency paediatricsAnaphylaxisMRCPCH FOP

A 7-year-old boy develops wheeze, lip swelling and widespread urticaria five minutes after eating a biscuit containing nuts. He is pale and his blood pressure is low for age. What is the most likely cause?

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Correct answer: B — IgE-mediated mast-cell degranulation after nut exposure

Rapid wheeze, angio-oedema, urticaria and hypotension after nut exposure indicate anaphylaxis from mast-cell mediator release. Hereditary angio-oedema can cause swelling but typically lacks urticaria and bronchospasm. Viral wheeze would not explain immediate hypotension and widespread urticaria after exposure. The pearl is that recognising the mechanism should lead directly to intramuscular adrenaline in practice.

Reference: Resuscitation Council UK Anaphylaxis guideline; BNFc adrenaline