IGHE and anaphylaxis: For instance, food-dependent, exercise-induced anaphylaxis occurs when food and exercise are tolerated independently, but reactions occur when physical exertion follows ingestion of a food allergen.15 Secondly, a condition called alpha-gal syndrome presents a true IgE-mediated allergy to red meat, but the timing of symptoms is delayed by 2–6 h,16 resulting in the phrase ‘midnight anaphylaxis’.17 These examples provide the potential limitations of an allergy-focused history and further demonstrate the fact that diagnosis in allergic conditions is a process rather than a single investigation.