It is estimated that about 100-200 individuals in the US die each year from food-allergic reactions. Based on a few reports, individuals at increased risk for fatal anaphylaxis include those who delay treatment with epinephrine, have asthma, have experienced prior severe food allergic reactions, or who deny ongoing symptoms. Teenagers appear to be at particular risk. Usually these deaths are caused by a known food allergy while away from home and the fatal flaw is the failure to promptly administer epinephrine. Many of the children reported with fatal reactions had a biphasic reaction. They had initial mild symptoms within 30 minutes of ingesting the food that resolved only to have a recurrence of severe symptoms 1-2 hours following the ingestion. Thus, it is vitally important to observe patients with an acute anaphylactic reaction for at least 4 hours prior to discharge from the emergency room. Additionally, fifteen percent of those with severe reactions and 80% with fatal reactions had no skin symptoms. Thus, the absence of skin symptoms does not exclude the possibility of anaphylaxis.