BACKGROUND: Failure to promptly recognize and treat anaphylaxis can result in death. Understanding the incidence, etiology, and management is imperative. A previous pediatric study identified latex as the most common anaphylaxis allergen. We aim to describe the incidence, etiology, and management of anaphylaxis prelatex and postlatex-precaution implementation. METHODS: Retrospective review of inpatient and emergency department (ED) records of pediatric anaphylaxis patients seen at 1 institution between 1986 and 1990 or 2002 and 2006 was performed. Patients with 2 systemic symptoms (gastrointestinal, respiratory, hypotension/syncope, oropharyngeal, altered mental status) or 1 systemic symptom plus 1 cutaneous symptom (urticaria, edema, or flushing) were included. RESULTS: Fifty-three episodes were included from 1986 to 1990. A total of 117 episodes were included from 2002 to 2006. Approximately 80% of cases presented to the ED. From 1986 to 1990, we noted 30.5 cases per 100,000 ED visits versus 38 cases per 100,000 ED visits from 2002 to 2006. Food allergens were most common in both groups (43%). Latex accounted for only 1.9% of cases in 1986 to 1990 versus 1.7% postlatex precautions. Prehospital epinephrine use was poor. Patients in 2002 to 2006 were more likely to receive steroids, H2-blockers, epinephrine autoinjectors, and allergist referrals but less likely to receive epinephrine. CONCLUSIONS: The etiology of pediatric anaphylaxis has not significantly changed over time but seems to differ across regions because latex was not a significant allergen at this institution in either period. The incidence of anaphylaxis has increased slightly. Anaphylaxis remains underdiagnosed and undertreated. Improved education of patients/caregivers and health care providers is needed.