Comorbid asthma, COPD, cardiovascular disease, and advanced age increase the risk of poor outcomes. Alpha-Blockers, Beta-blockers, and ACE inhibitors can interfere with physiologic compensatory mechanisms during anaphylactic shock. Beta-blockers can lead to unopposed alpha stimulation with epinephrine administration, resulting in hypertension and diminished bronchodilator effect. Alpha-blockers may reduce epinephrine’s effect at alpha receptors. Ace inhibitors prevent the formation of angiotensin II and reduce the degradation of kinins, which can worsen anaphylactic shock. Ethanol and NSAIDS can lead to nonimmunologic mast cell activation.