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A 3-year-old boy with severe atopy, neurodermatitis, allergic rhinitis, conjunctivitis, markedly elevated IgE (>1500 kU/L) and polysensitisation to multiple allergens presented with acute life-threatening respiratory failure. Since infancy, he had suffered over 20 episodes of obstructive bronchitis and three emergency visits for hypoxia, including one following anaphylaxis to cashew nuts.