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Background and Objectives : A peanut allergy is the most common single cause of anaphylaxis in children. The risk factors for anaphylaxis in children with a peanut allergy are not well defined. Therefore, we aimed to identify epidemiological, clinical, and laboratory characteristics of children with a peanut allergy that may predict the severity of the allergic reaction and anaphylaxis. Materials and Methods : We conducted a cross-sectional study and included 94 children with a peanut allergy. Allergy testing was performed, including skin prick testing and the determination of specific IgE levels to peanuts and their Ara h2 component. In case of discordance between patient history and allergy testing, an oral food challenge with peanuts was performed. Results : Anaphylaxis and moderate and mild reactions to peanuts occurred in 33 (35.1%), 30 (31.9%), and 31 (33.0%) patients, respectively. The severity of the allergic reaction was only weakly correlated ( p = 0.04) with the amount of peanuts consumed. The median number of allergic reactions to peanuts was 2 in children with anaphylaxis compared to 1 in other patients ( p = 0.04). The median level of specific IgE to Ara h2 was 5.3 IU/mL in children with anaphylaxis compared to 0.6 IU/mL and 10.3 IU/mL in children with mild and moderate peanut allergies ( p = 0.06). The optimal cutoff for distinguishing between anaphylaxis and a less severe allergic reaction to peanuts was a specific IgE Ara h2 level of 0.92 IU/mL with 90% sensitivity and 47.5% specificity for predicting anaphylaxis ( p = 0.04). Conclusions : Epidemiological and clinical characteristics of the patient cannot predict the severity of the allergic reaction to peanuts in children. Even standard allergy testing, including component diagnostics, is a relatively poor predictor of the severity of an allergic reaction to peanuts. Therefore, more accurate predictive models, including new diagnostic tools, are needed to reduce the need for oral food challenge in most patients.