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AND AT LEAST ONE OF THE FOLLOWING: A. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF in older children and adults, hypoxemia) B. Reduced BP* or associated symptoms of end-organ dysfunction (eg, hypotonia, collapse, syncope, incontinence) 2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to a LIKELY allergen for that patient (minutes to several hours): A. Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula) B. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF in older children and adults, hypoxemia) C. Reduced BP* or associated symptoms (eg, hypotonia, collapse, syncope, incontinence) D. Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting) 3. Reduced BP* after exposure to a KNOWN allergen for that patient (minutes to several hours): A. Infants and children: low systolic BP (age specific)* or greater than 30 percent decrease in systolic BP B. Adults: systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline PEF: peak expiratory flow; BP: blood pressure. * Low systolic blood pressure for children is defined as: - less than 70 mmHg from one month to one year, - less than (70 mmHg + [2 x age]) from 1 to 10 years, and - less than 90 mmHg from 11 to 17 years Adapted with permission from: Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report-Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117:391. Copyright © 2006 The American Academy of Allergy, Asthma, and Immunology.