A 19-year-old male is brought to the emergency department by ambulance after collapsing at a restaurant. He was dining with friends and consumed a dish containing a mole sauce. Approximately 10 minutes after the meal, he began to complain of itchy palms, generalized warmth, and a sensation of tightness in his throat. He then developed nausea and vomited twice. His friends report that he has a known history of peanut allergy and asthma, but he does not currently have an epinephrine auto-injector in his possession. He has had no hospitalizations for asthma in the past year and uses an albuterol inhaler occasionally for exercise-induced symptoms. He takes no other medications and has no known drug allergies. Upon arrival, he is anxious and struggling to breathe.

His temperature is 98.6^o F (37^o C), pulse is 115 bpm, respirations are 28/min, and blood pressure is 95/60 mm Hg. He is in acute distress, alert but anxious, and speaks in short phrases due to shortness of breath.