Anaphylaxis — DCE Clinical Case

Focused history — what you must establish

• Episode reconstruction, hour by hour: for each episode — everything eaten in the preceding six hours and exactly when, alcohol, exercise before or after eating, NSAIDs or other new medicines, intercurrent illness, insect exposure, menstruation, and the first symptom with its progression ^[1].
• Severity markers: which systems were involved, whether hypotension or collapse occurred, adrenaline doses required, and whether symptoms recurred after resolution — her second episode needing two doses marks her as a higher-risk phenotype ^[2].
• The running clue: the second episode during a run after an evening meal raises food-dependent exercise-induced anaphylaxis — ask specifically what she ate before running, and whether the same meal without exercise has ever caused symptoms ^[6].
• Cofactor and medication audit: regular and intermittent NSAIDs, any ACE inhibitor or beta-blocker, asthma or eczema history, and alcohol patterns — each amplifies reactions, and the cardiovascular drugs worsen outcomes ^[2].
• The safety-net gap: what she was actually discharged with, whether she can use the device, what she has been told, and what she now avoids — one device, no training and no plan is the commonest systems failure in this case ^[1].
• Her frame: food anxiety, fear around running, and what she most wants to be able to do safely.