Anaphylaxis in children presents most frequently with respiratory features, and concern exists about the potential for diagnostic confusion with acute asthma. 84 cases of asthma requiring intensive care were identified. 11 cases met exclusion criteria, which left 73 cases for analysis using established anaphylaxis diagnostic criteria. 13/73 children (17.8%) were found to have sufficient clinical features for a diagnosis of anaphylaxis to be entertained, with 3/73 cases (4.1%) considered highly likely to be anaphylaxis. This study highlights the potential for diagnostic confusion and demonstrates the need to consider anaphylaxis in all children presenting with severe asthma.