The FIRST clinical SIGN of anaphylaxis is typically:

Correct answer: B. Skin rash / urticaria (hives) — cutaneous manifestations are usually first

• A. Hypotension is a later, serious manifestation of cardiovascular involvement.
• B. Correct. Anaphylaxis typically progresses in a sequence: (1) SKIN manifestations FIRST — erythema, urticaria (hives), pruritus, angioedema, flushing (80-90% of cases), (2) Respiratory — bronchospasm, stridor, dyspnea, (3) Cardiovascular — hypotension, tachycardia, (4) GI — nausea, vomiting. The skin is the earliest and most common first sign. This makes skin changes the diagnostic 'warning sign' to begin treatment before progression to life-threatening stages.
• C. Bronchospasm typically follows the initial skin reaction.
• D. Loss of consciousness indicates severe cardiovascular collapse — a late and critical stage.