Purpose of the review <p>Anaphylaxis in infants presents a complex diagnostic and therapeutic challenge due to atypical presentations and communication barriers. This review aims to synthesize the current understanding of this condition, focusing mainly on the clinical phenotype of children under 2 years of age, the evolution of age-specific diagnostic criteria, and evidence-based recommendations for acute and long-term management, with the aim of improving outcomes in these patients.</p> Recent findings <p>A recent international consensus, outlined in the GALEN 2024 report, has established a unified clinical framework and diagnostic decision support tool to standardize the recognition of anaphylaxis across all ages. This tool explicitly integrates baby-specific signs into a structured diagnostic algorithm. Recently proposed and validated diagnostic criteria for infants and toddlers, such as bowing, drooling, and itching, among others, expand the classic list of symptoms to mitigate the historically low sensitivity of traditional criteria in this population group.</p> Abstract <p>The diagnosis of anaphylaxis in infants is fraught with difficulties, often leading to underdiagnosis and a dangerous delay in the initiation of treatment. The central principle of management remains the rapid administration of intramuscular adrenaline. The recent development and dissemination of diagnostic tools adapted to the baby represents a fundamental advance for early recognition and intervention. Comprehensive long-term care requires identification of triggers, meticulous caregiver education, a written action plan for anaphylaxis, and follow-up with a childhood allergy specialist. The implementation and prospective validation of these new diagnostic frameworks in clinical practice are essential steps to reduce morbidity and mortality in this vulnerable age group.</p>