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A 15-year-old girl whom you have been following since birth is rushed to the local emergency department (ED) following dinner at the family’s favorite restaurant. During the meal, she developed facial flushing, acute urticaria, vomiting, and diarrhea. In the ED, she is given epinephrine and diphenhydramine, and the symptoms resolve. At a follow-up visit the next day in your office, the girl’s mother informs you that her daughter had eaten cashew-crusted tuna with a serving of fresh fruit, including mango, papaya, and kiwi.

A 4-year-old boy is playing outside and is stung by an unidentified insect. He runs inside crying, and his mother cleans the sting site on his hand. Over the next 2 hours, the hand and distal forearm become red, swollen, and pruritic. His mother takes him to a local ED. He is given diphenhydramine and parenteral corticosteroids and...

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