To cite this article: Calvani M, Cardinale F, Martelli A, Muraro A, Pucci N, Savino F, Zappalà D, Panetta V, the Italian Society of Pediatric Allergy and Immunology (SIAIP) anaphylaxis’ study group. Risk factors for severe pediatric food anaphylaxis in Italy. Pediatr Allergy Immunol 2011: 22: 813–819. Background:  Little is known about the cause of food‐induced anaphylaxis in children or about the factors that might affect its clinical severity. Objective:  The aim of this study was to investigate the cause of food‐induced anaphylaxis in children in Italy and to identify factors that could influence the appearance of symptoms and the severity of anaphylaxis. Methods:  One hundred and sixty‐three children with anaphylaxis consecutively attending 29 outpatient allergy clinics throughout Italy were enrolled in this prospective study. Information about past anaphylaxis episodes was collected with a standardized questionnaire. Food sensitization was evaluated by skin‐prick test. Results:  A clinical history of asthma increased the risk of wheezing odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1–4.5 and respiratory arrest (OR 6.9; 95% CI 1.4–34.2). A clinical history of chronic/relapsing gastrointestinal symptoms increased the risk of vomiting (OR 2.1; 95% CI 0.9–4.3), hypotension (OR 7.9; 95% CI 1.9–32.0), and bradycardia/cardiac arrest (OR 9.2; 95% CI 0.9–91.3). The severity of present and previous episodes was similar only in patients with mild or moderate anaphylaxis. Peanut and egg were the most frequent causes of severe anaphylaxis. Conclusions:  A clinical history of asthma and chronic/relapsing gastrointestinal symptoms (probably linked to food allergy) may predict the development of respiratory and gastrointestinal symptoms and the severity of anaphylaxis.