A 2-Year-Old Boy Is Brought to the Emergency Department Due

A 2-year-old boy is brought to the emergency department due to wheezing and difficulty breathing.  The patient had been trick-or-treating with his parents and ate several packs of candy containing peanuts.  After he receives an intramuscular epinephrine injection, his symptoms resolve.  At a follow up appointment, an allergy specialist places droplets of various allergens on the patient's skin and punctures the epidermis at each site.  After 15 minutes, the skin at the site with peanut extract is erythematous with a raised, itchy bump that improves by the time the family leaves the office.  Four hours later, the parents notice a hard, red swelling at the puncture site.  Which of the following is most likely involved in this secondary reaction?

A) Cell lysis following IgG autoantibody binding
B) Complement activation by immune complexes
C) Epithelial damage by major basic protein
D) IgE-mediated histamine release from mast cells
E) Interferon gamma release from CD4⁺ T cells

Correct Answer:

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