Aim: Medical and lay concerns about food allergy are increasing. Whilst food a llergy may be becoming more common, fatal reactions to food in childhood are ver y rare and their rate is not changing. We sought to establish how common severe reactions are. Methods: Prospective survey, 1998 to 2000, of hospital admissions for food-allergic reactions-conducted primarily through the British Paediatri c Surveillance Unit, covering the 13 million children in the United Kingdom and Ireland. Results: 229 cases reported by 176 physicians in 133 departments, yield ing a rate of 0.89 hospital admissions per 100 000 children per year. Sixty-fiv e per cent were male, 41%were under 4 y and 60%started at home. Main allergens were peanut (21%), tree nuts (16%), cow’s milk (10%) and egg (7%). Main sy mptoms were facial swelling (76%), urticaria (69%), respiratory (66%), shock (13%), gastrointestinal (4%). Fiftyeight cases were severe. Three were fatal, six near fatal, and 8 of these 9 had asthma with wheeze being the life-threaten ing symptom. Three near-fatal cases received excess intravenous epinephrine. No ne of the non-fatal reactions resulted in mental or physical impairment. Seven of 171 non-severe and 6/58 severe cases might have had a worse outcome if epine phrine auto-injectors had been unavailable. Six of the severe cases might have benefited if auto-injectors had been more widely prescribed. Conclusion: In the United Kingdom and Ireland, the incidence of severe reactions is low. The study highlights that: asthma is a strongly significant risk factor for a severe reac tion and therefore warrants optimal management; severe wheeze is a prominent fea ture of severe reactions and warrants optimal management; intravenous epinephrin e should be used with great care if needed. Epinephrine auto-injectors do not a lways prevent death, but our study design and data do not allow a definite state ment about whether overall they are beneficial. Ailst: Medical and lay concerns about food allergy are increasing. Whilst food a llergy may be becoming more common, fatal reactions to food in childhood are ver y rare and their rate is not changing. We sought to establish how common severe reactions are. Methods : Prospective survey, 1998 to 2000, of hospital admissions for food-allergic reactions-conduct primarily through the British Paediatri c Surveillance Unit, covering the 13 million children in the United Kingdom and Ireland. Results: 229 cases reported by 176 physicians in 133 departments , yield ing a rate of 0.89 hospital admissions per 100 000 children per year. Sixty-fiv e per cent were male, 41% were under 4 y and 60% started at home. Main allergens were peanut (21%), tree nuts Main symptoms were facial swelling (76%), urticaria (69%), respiratory (66%), shock (13%), gastrointestinal (4% Three were fatal, six near fatal, and 8 of these 9 had asthma with wh No of the non-fatal reactions derived in mental or physical impairment. Seven of 171 non-severe and 6/58 severe cases might have had a The outcome of if epine phrine auto-injectors had been unavailable. Six of the severe cases might have benefited if auto-injectors had been more widely prescribed. Conclusion: In the United Kingdom and Ireland, the incidence of severe reactions is low. that: asthma is a strongly significant risk factor for a severe reac tion and therefore warrants optimal management; severe wheeze is a prominent fea ture of severe reactions and warrants optimal management; intravenous epinephrin e should be used with great care if needed. Epinephrine auto- injectors do not a lways prevent death, but our study design and data do not allow a definite state ment about whether overall are being beneficial.