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Anaphylaxis is an acute and potentially lethal syndrome involving multiple systems after exposure to certain substances. Here we have a 60-year-old male presented with typical substernal chest pain radiating to the left arm. The physical exam was unremarkable. EKG showed sinus rhythm without ST-T changes. Initial troponin was elevated. He was diagnosed with non-ST-elevation myocardial infarction and was loaded with dual antiplatelets, high-intensity statin, therapeutic anticoagulant. Patient underwent left heart catheterization and coronary angiography. It revealed mid-LAD eccentric 70-80% lesion. The rest of the coronary arteries were free of disease. A stent was deployed to mid LAD. Immediately after deployment, the patient became hypotensive, nauseous, and vomited. He was intubated for airway protection, started with aggressive fluid resuscitation, sedation reversal and eventually started on vasopressors. On the monitor, ST elevation was noted in the inferior leads and aVL, so a repeat left coronary angiography was performed. The left circumflex artery was completely occluded in its mid portion. A balloon angioplasty was performed, which opened the left circumflex artery. He also received nitroglycerin for concern of vasospasm and steroids for anaphylactic reaction. An intra-aortic balloon pump was placed to support hemodynamic stability. He was found to have diffuse rashes on his body after the procedure which was consistent with anaphylactic reaction. The patient improved significantly and was discharged from hospital on post-op day 3. This case illustrates the first case describing coronary artery occlusion secondary to anaphylactic shock with real-time angiography. Management includes standard protocol (epinephrine, corticosteroid, and antihistamine), maintaining blood pressure and using nitrate and balloon angioplasty to relieve vascular spasm.