Original Article

Characteristics, Etiology and Treatment of Pediatric and Adult Anaphylaxis in Iran


Despite the increasing prevalence of anaphylaxis, there is little information about the characteristics and practice of healthcare providers in treating anaphylaxis, so this study was conducted to record the characteristics and therapeutic approaches of anaphylaxis from May 2012 until April 2015, the data of all patients diagnosed with anaphylaxis in the Allergy department of three referral university hospitals in Tehran, Iran were recorded. Thereafter, the demographics, clinical features, triggers and therapeutic approach were evaluated. This study investigated 136 individuals, 64 males (47%) between 6 months and 68 years old, as well as 72 others (52.94%) under 18 years of age (pediatric). The following were the most common organs involved: Skin 86.02% (pediatric 91.66% vs adult 79.68%), respiratory tract 51.47% (pediatric 43.05% vs adult 60.93%), cardiovascular 50.73% (pediatric 54.16% vs adult 46.87%), gastrointestinal 20.58% (pediatric 27.7% vs adult 12.5% ) and neurologic system 5.88% (only in adults). The following were the most identified causing foods 69 (50.37%)[42 pediatric (children) and 27 adults], drugs 34( 25%)[14 pediatric and 20 adults], idiopathic 16( 11.77%)[3 pediatric and 13 adults], insect sting 7( 5.15%)[3 pediatric and 4 adults] , exercise 6( 4.42%) [1 pediatric and 5 adults]. Milk, egg and wheat were the most common causative foods in pediatric cases but sesame, as well as egg and milk were the most common causes in adults. Epinephrine injection, auto injector epinephrine prescription as a discharging plan and referral to an allergist were: 10.78, 1.96 and 7.8 %, respectively. In this case series we found that, cutaneous, respiratory, cardiovascular and gastrointestinal complains were the most common manifestations and food, drug and idiopathic were the most common causes.In this study, the diagnosis of anaphylaxis, epinephrine subscription and referral to an allergist were significantly lower in comparison to other studies.

Lieberman PL. Recognition and first-line treatment of anaphylaxis. Am J Med 2014; 127(1 Suppl):S6-11.

2. Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the european academy of allergy and clinical immunology. Allergy 2014; 69(8):1026-45.

3. Teymourpour P1, Pourpak Z, Fazlollahi MR, Barzegar S, Shokouhi R, Akramian R, et al. Cow’s Milk Anaphylaxis in Children First Report of Iranian Food Allergy Registry. Iran J Allergy Asthma Immunol 2012; 11(1): 29-36.

4. Teymourpour P, Shokouhi R, Fazlollahi MR Movahedi M, Mansouri M, Mirsaeedghazi B, et al. Factors Affecting the Severity of Cow’s Milk Anaphylaxis. Iran J Allergy Asthma Immunol 2013; 12(2):190-1.

5. Campbell RL, Li JT, Nicklas RA, Sadosty AT; Members of the Joint Task Force; Practice Parameter Workgroup. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol 2014; 113(6):599-608.

6. Nowak R, Farrar JR, Brenner BE, Lewis L, Silverman RA, Emerman C, et al. Customizing anaphylaxis guidelines for emergency medicine. J Emerg Med 2013; 45(2):299-306.

7. Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy 2015; 45(6):1027-39.

8. Ben‐Shoshan M, Clarke AE. Anaphylaxis: past, present and future. Allergy 2011; 66(1):1-14

9. Koplin JJ, Martin PE, Allen KJ. An update on epidemiology of anaphylaxis in children and adults. Curr Opin Allergy Clin Immunol 2011; 11(5):492-6.

10. Fineman SM, Bowman SH, Campbell RL Dowling P, O'Rourke D, Russell WS, et al. Addressing barriers to emergency anaphylaxis care: from emergency medical services to emergency department to outpatient follow-up. Ann Allergy Asthma Immunol 2015; 115(4):301-5.

11. Greenberger PA, Rotskoff BD, Lifschultz B. Fatal anaphylaxis: postmortem findings and associated comorbid diseases. Ann Allergy Asthma Immunol 2007; 98(3):252-7.

12. Sclar DA, Lieberman PL. Anaphylaxis: underdiagnosed, underreported, and undertreated. Am J Med 2014; 127(1 Suppl):S1-5.

13. Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, et al. Anaphylaxisda Practice Parameter Update 2015. Ann Allergy Asthma Immunol 2015; 115(5):381-4.

14. Adkinson Jr NF, Bochner BS, Burks AW et al. 2013. Middleton's allergy: principles and practice: Elsevier Health Sciences

15. Yi-Chen H, Yi-Chin H, Jing-Long H, Kuo-Wei Y. Clinical features of adult and pediatric anaphylaxis in Taiwan. Asian Pac J Allergy Immunol 2011; 29(4):307-12.

16. Blackhall M, Edwards D. 2015. Incidence and patient demographics of pre-hospital anaphylaxis in Tasmania. Australasian Journal of Paramedicine 12

17. Barzegar S, Akramian R, Pourpak Z Bemanian MH, Shokouhi R, Mansouri M, et al. Common Causes of Anaphylaxis in Children The First Report of Anaphylaxis Registry in Iran. World Allergy Organ J 2010; 3(1):9–13.

18. Worm M, Edenharter G, Ruëff F, Scherer K, Pföhler C, Mahler V, Symptom profile and risk factors of naphylaxis in Central Europe. Allergy 2012; 67(5):691-8.

19. Yang MS, Lee SH, Kim TW, Kwon JW, Lee SM, Kim SH, et al. 2008. Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol 2008; 100(1):31-6.

20. Wood RA, Camargo CA, Lieberman P Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol 2014; 133(2):461-7.

21. Jiang N, Yin J, Wen L, Li H. Characteristics of Anaphylaxis in 907 Chinese Patients Referred to a Tertiary Allergy Center: A Retrospective Study of 1,952 Episodes. Allergy Asthma Immunol Res 2016; 8(4):353-61.

22. Kimchi N, Clarke A, Moisan J Lachaine C, La Vieille S, Asai Y, et al. Anaphylaxis cases presenting to primary care paramedics in Quebec. Immun Inflamm Dis 2015; 3(4):406-10.

23. Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010; 125(6):1322-6.

24. Tejedor-Alonso M, Moro-Moro M, Múgica-García M. Epidemiology of Anaphylaxis: Contributions From the Last 10 Years. J Investig Allergol Clin Immunol 2015; 25(3):163-75.

25. O'Keefe A, Clarke A, Pierre YS et al. 2016. The Risk of Recurrent Anaphylaxis. The Journal of Pediatrics

26. Stukus DR, Mikhail I. Pearls and Pitfalls in Diagnosing IgE-Mediated Food Allergy. Curr Allergy Asthma Rep 2016; 16(5):1-10.

27. Akin C. Anaphylaxis and mast cell disease: what is the risk? Curr Allergy Asthma Rep 2010; 10(1):34-8.

28. Gülen T, Hägglund H, Dahlén S-E, Sander B, Dahlén B, Nilsson G. Flushing, fatigue, and recurrent anaphylaxis: a delayed diagnosis of mastocytosis. Lancet 2014; 383(9928):1608.

29. Valent P. Risk factors and management of severe life‐threatening anaphylaxis in patients with clonal mast cell disorders. Clin Exp Allergy 2014; 44(7):914-20.

30. Tejedor-Alonso M, Mugica-García M, Esteban-Hernández J Moro MM, Ezquerra PE, Ingelmo AR,
et al. A study of recurrence of anaphylaxis in a spanish anaphylaxis series. J Investig Allergol Clin Immunol 2013; 23(6):383-91.

31.Alonso M, García M, Hernández JE, Moro MM, Ezquerra PE, Ingelmo AR,et al. Recurrence of anaphylaxis in a Spanish series. J Investig Allergol Clin Immunol 2013; 23(6):383-91.

32. Mullins R. Anaphylaxis: risk factors for recurrence. Clin Exp Allergy 2003; 33(8):1033-40.

33. Brown AF, McKinnon D, Chu K. Emergency department anaphylaxis: a review of 142 patients in a single year. J Allergy Clin Immunol 2001; 108(5):861-6.

34. Brown S, Blackman K, Stenlake V, Heddle R. Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J 2004; 21(2):149-54.

35. Hussain AM, Yousuf B, Khan MA, Khan FH, Khan FA. Vasopressin for the management of catecholamine-resistant anaphylactic shock. Singapore Med J 2008; 49(9):e225-8.

36. Babaie D, Nabavi M, Arshi S, Mesdaghi M, Chavoshzadeh Z, Bemanian MH, et al. Cow’s Milk Desensitization in Anaphylactic Patients: A New Personalized-dose Method. Iran J Allergy Asthma Immunol 2017; 16(1):45-52.

37. M Nabavi, M Rekabi, S Arshi et al. Evaluation of total and specific IgE in serum of wheat allergy patients before and after of desensitization. Razi Journal of Medical Sciences 23 (144), 100-108

38. Simons FER, Organization WA. World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings. Ann Allergy Asthma Immunol 2010; 104(5):405-12.

39. Mostmans Y, Grosber M, Blykers M, Mols P, Naeije N, Gutermuth J. Adrenaline in anaphylaxis treatment and self‐administration: experience from an inner city emergency department. Allergy 2017; 72(3):492-7.

40. Sidhu N, Jones S, Perry T, Thompson T, Storm E, Melguizo Castro MS, et al. Evaluation of Anaphylaxis Management in a Pediatric Emergency Department. Pediatr Emerg Care 2016; 32(8):508-13.

41. Alangari AA. 2014. Characteristics of patients presenting to the emergency department with anaphylaxis in Riyadh, Saudi Arabia. Journal of Taibah University Medical Sciences 9: 318-21

42. Hitti EA, Zaitoun F, Harmouche E, Saliba M, Mufarrij A. Acute allergic reactions in the emergency department: characteristics and management practices. Eur J Emerg Med 2015; 22(6):253-9.

IssueVol 16, No 6 (2017) QRcode
SectionOriginal Article(s)
Adult anaphylaxis Anaphylaxis registry Anaphylaxis etiology Anaphylaxis treatment Children anaphylaxis

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How to Cite
Nabavi M, Lavavpour M, Arshi S, Bemanian MH, Esmaeilzadeh H, Molatefi R, Rekabi M, Ahmadian J, Eslami N, Shokri S, Darabi K, Sedighi GR, Fallahpour M. Characteristics, Etiology and Treatment of Pediatric and Adult Anaphylaxis in Iran. Iran J Allergy Asthma Immunol. 2017;16(6):480-487.