Anaphylaxis, an acute, systemic, potentially life-threatening allergic reaction, is so commonly misdiagnosed or underreported that reliable statistics about it are elusive, but its prevalence is increasing. Swift intervention is required, followed by comprehensive follow-up, including development of an emergency action plan. Yet alarmingly wide gaps are documented between usual care and optimal, guidelines-concordant anaphylaxis care. These gaps are apparent among emergency department (ED) personnel as well as allergists, primary care physicians, and others. Anaphylaxis recognition and diagnosis are challenging, familiarity with management guidelines is suboptimal, and too few understand that first-line treatment, whether in a clinical setting or when administered by patients/caregivers, should always be epinephrine. Furthermore, patients frequently get inadequate follow-up, although they require testing to identify triggers, counseling about trigger avoidance, and prescriptions for epinephrine autoinjectors along with clear instructions about why, how, and when to use them.