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Previous Volume 335:1925-1926 December 19, 1996 Number 25 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: In the Clinical Problem-Solving article entitled "The Domino Principle" (Aug. 1 issue),¹ Jaffe and Zahger describe an assumed anaphylactic reaction that produced shock and subsequent myocardial ischemia. What is unusual in this case is the presence of sinus rhythm of 90 beats per minute in a patient who is assumed to be in anaphylactic shock and who is not receiving beta-adrenergic blockers. By virtue of the clinical presentation of shock, normal sinus rhythm without tachycardia is extremely unusual, especially in anaphylactic reactions.² The release of histamine during anaphylaxis causes marked increases in sympathoadrenergic tone and directly stimulates . . . [Full Text of this Article]

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