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We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88\u00a0studies and synthesized the evidence narratively, undertaking meta\u2010analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and\/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food\u2010dependent exercise\u2010induced anaphylaxis may be an exception. Some medications such as beta\u2010blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life\u2010threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. 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