A previously healthy five-year-old boy presented to a community paediatrician’s office for a well-child visit with his mother and younger sister. Parental concerns at the time included nightmares and intermittent nocturnal enuresis. No other issues were identified. In the past, the patient was treated for several conditions: recurrent otitis media (bilateral myringotomies and tube insertion at 21 months of age), asthma (salbutamol and fluticasone propionate as required) and eczema (in infancy). The patient was also recently investigated for food allergies after developing one hive on his face following ingestion of pine nuts. He had previously tolerated other tree nuts, eggs, milk and fish with no untoward reactions. Skin testing for pine nut allergy was negative. He was on no medications and had no drug allergies to date. His immunizations were up to date. Both parents had seasonal allergic rhinitis and the patient’s sister had eczema. There were no pets or smokers in the home. Physical examination revealed a happy, well-looking boy with growth parameters on the 50th percentile (height and weight). The rest of the examination was entirely normal. The visit concluded with the administration of the five-year-old diphtheria, tetanus and acellular pertussis (DTaP)-poliomyelitis booster. On explanation of the possible side effects, the patient immediately became anxious, screaming and crying even after the procedure was completed. Within 5 min, the patient’s mother returned to the office and said that there was something wrong with her son. He was complaining of burning eyes and lips. A brief examination revealed increasing angioedema of the eyelids (and lips to a lesser extent), and widespread urticarial lesions on the abdomen, back, arms and legs. There was no wheezing on auscultation of the chest and no tongue swelling. Due to the urgency of the clinical situation, pulse and blood pressure were not measured because the doctor was attending to the preparation and administration of epinephrine. Both the patient and his mother were very distraught. Due to the boy’s anxiety and lack of cooperation, it took four adults, including the doctor, to administer 0.15 mg of epinephrine intra-muscularly in the left thigh. A total of 30 mL (75 mg) of diphenhydramine elixir was then given by mouth, again with the aid of several adults. The child was transported to the closest hospital for further assessment and treatment. He did not require any further epinephrine and received only diphenhydramine on an as-needed basis on discharge.