A relationship between serum basal tryptase (sBT) levels, anaphylactic reactions, and clonal mast cell diseases was shown recently in adults with venom allergy, but the relationship between sBT levels and IgE-mediated food allergy and anaphylaxis is not known. In this study, children with food allergy (FA; n=167) were analyzed in two groups according to the presence (FA+/A+; n=79) or absence of anaphylaxis (FA+/A-; n=88) and were compared with a control group (n=113). Median sBT values in FA+/A+, FA+/A-, and control groups were 4.0ng/ml (2.8-5.8), 3.6 (2.3-4.5), and 3.3 (2.4-4.4), respectively (P=0.022). sBT measurements higher than the cutoff values of 5.7 and 14.5 were associated with 50% and 90% predicted probabilities, respectively, of moderate to severe anaphylaxis. Children with tree nuts/peanut allergies had significantly higher levels of sBT than children with milk and egg allergy (P=0.022). Results suggest that sBT levels may predict moderate to severe anaphylaxis in children with food allergy, which may follow a particular pattern according to the food allergy phenotype.