BACKGROUND: Incidence and severity of childhood food allergy increased during the past 2 decades and that pediatric emergency department visits and death occurring due to food-induced anaphylaxis also increased in Western countries. METHODS: To evaluate the incidence and clinical characteristics of pediatric emergency department visits due to severe forms of food allergy in Korea, data were collected from 305 with urticaria, angioedema or anaphylaxis of 78,889 children aged < or =18 or younger than 18 years who visited the emergency departments between of 9 hospitals in 8 cities in Korea June 2008 and March 2009. The incidence and clinical characteristics of childhood food allergy were evaluated using the detailed medical records. RESULTS: Of 78,889 children, 169 (0.214%) showed food-related systemic urticaria, angioedema or anaphylaxis. Of the 57 children with anaphylaxis, 36 of which (63.16%) were food-related. The incidence of food-related anaphylaxis was 4.56 per 10,000 pediatric emergency department visits. Cutaneous symptoms (92.8%) were the most common anaphylaxis followed by cardiovascular (29.82%), gastrointestinal (28.07%), and respiratory symptoms (24.56%). The most common offending food allergen was fish, followed by cow's milk, other seafoods, chicken, pork, egg, walnut, pupa, peanut, beef and buckwheat. There were no cases of death from anaphylaxis in this study. CONCLUSION: This is the first study to evaluate the incidence of pediatric emergency department visits and severity of childhood food allergy in Korea. The causative food allergens and clinical characteristics of pediatric emergency department visits due to food allergy in Korean children have been surveyed.