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A 35-year-old fitness trainer suddenly develops facial swelling and widespread wheeze while leading a high-intensity interval training class. He had eaten shellfish two hours earlier. On assessment, he appears flushed, tachypnoeic, and his systolic BP is unrecordable by cuff; the radial pulse is rapid and weak.
What is the most likely underlying mechanism?

Cholinergic urticaria

Bradykinin accumulation from unrecognised HAE

Serotonin release from carcinoid syndrome

Food-dependent, exercise-induced anaphylaxis

Histamine fish poisoning

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