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The peculiar shape of the foreign body prevented penetration into the airway. The foreign body was removed under local anaesthesia and recovery was uneventful. Laryngeal foreign bodies are easily diagnosed because of  obvious signs and symptoms; rarely, they remain impacted in the larynx since they are either coughed out or inhaled.1 Usually airways foreign bodies in adults are associated with altered mental status or neurological dysfunction which our patient did not have, nor did he have signs suggesting the presence of a foreign body in the airway. Foreign body inhalation, however, may occur unnoticed in healthy subjects2 and may not provoke cough or other obvious symptoms, a part from mild dysphagia and discomfort and in the throat. Figure?1 The plastic foreign body impacted on the epiglottis. Learning point The aspiration of foreign bodies represents a critical situation that must always be classified as an emergency. In this case, the foreign body fortunately remained impacted around the epiglottis and did not obstruct the tracheo [http://www.selleckchem.com/products/PF-2341066.html Crizotinib clinical trial] bronchial tree. Foreign bodies of upper airways must be suspected also in  the absence of cough, dyspnoea or hoarseness. Footnotes Contributors: MP writing of the article; MBG author of the photograph and writing of the article; and GB revision of the article. Competing interests: None.  Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""Contrast media-related life-threatening anaphylactic reactions are rare (according to Lange,1 a life-threatening reaction related to contrast during diagnostic catheterisation is 0.2%). Sometimes these life-threatening situations may pose diagnostic uncertainty as there may be a delay in the appearance of a typical rash. During cardiac catheterisation, the contrast media used can cause anaphylaxis (or anaphylactoid reactions) leading to severe cardiovascular collapse and shock. Most of these cases can be managed successfully with fluid resuscitation and drugs,2 which include steroids, H1 receptor blockers (antihistamines), adrenaline and potent vasoconstrictors (metaraminol or vasopressin when adrenaline is ineffective). However, the use of intra-aortic balloon counter pulsation in anaphylaxis-induced cardiogenic shock is not well documented apart from isolated case reports.3 4 We describe a case of a severe contrast-induced anaphylactic shock during elective diagnostic coronary angiography (figure 1), which did not respond to the conventional medical therapy, while a prompt recognition of the anaphylactic shock (before the typical rash appeared) and insertion of the intra-aortic balloon pump (IABP) prevented death. Figure?1 Severe spasms of the left coronary arteries due to anaphylaxis.