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Acute onset cutaneous and/or mucosal involvement after antigen exposure, plus any of the following:

 Respiratory compromise

 Bronchospasm

 Stridor

 Hypoxia

 Cardiovascular compromise

 Hypotension

 Collapse

 Persistent gastrointestinal symptoms

 Vomiting

 Cramping abdominal pain

At the severe end of the allergic reaction spectrum is anaphylaxis. Anaphylaxis can be variable in presentation and is defined by rapid progression to multiple system involvement (Box 21.2). In general, the incidence of anaphylaxis is increasing. The most common triggers are insect stings and food ingestions, particularly nuts. Food ingestions are particularly concerning and often the most severe. The faster a reaction develops after exposure to an allergen, the more likely it is to be severe and life‐threatening.