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Statement of the Problem: Perioperative cases are at risk of allergic and anaphylactic reactions leading to immediate mortality and long term morbidity. Among them anaphylactic shock is the cause of immediate mortality. It results in significant personal, social and economic cost and the impact of allergy related complication may compound these costs. Causes: It happens because of use many drugs, different materials uses during perioperative period. Clinical presentation: Surgical Patients with perioperative anaphylactic shock incidence are at great risk of mortality. It happens in the form of bronchospasm, skin rashes, angioedema and severe intractable hypotension leading to death. Treatment: Management and alertness is essential for treatment. Management includes removal of the suspected and proven offending agent and contributing factors along with recsusitive measures in the form of iv antihistaminic drugs, IV fluid boluses, IM adrenaline, H2 blockers, endotracheal intubation, mechanical ventilation plus intensive vital monitoring. The purpose of this topic is to describe presentation of perioperative analphylaxis and management of anaphylactic shock.