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Li X, Ma Q, Yin J, Zheng Y, Chen R, Chen Y, Li T, Wang Y, Yang K, Zhang H, Tang Y, Chen Y, Dong H, Gu Q, Guo D, Hu X, Xie L, Li B, Li Y, Lin T, Liu F, Liu Z, Lyu L, Mei Q, Shao J, Xin H, Yang F, Yang H, Yang W, Yao X, Yu C, Zhan S, Zhang G, Wang M, Zhu Z, Zhou B, Gu J, Xian M, Lyu Y, Li Z, Zheng H, Cui C, Deng S, Huang C, Li L, Liu P, Men P, Shao C, Wang S, Ma X, Wang Q, Zhai S. A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020). Front Pharmacol 2022; 13:845689. [PMID: 35418863 PMCID: PMC8996305 DOI: 10.3389/fphar.2022.845689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns. Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis. Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects. Conclusion: For the emergency management of anaphylaxis we conclude that: • NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis • Prompt and proper administration of epinephrine is critical.
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Affiliation(s)
- Xiaotong Li
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,School of Pharmaceutical Science, Peking University, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Qingbian Ma
- Emergency Department, Peking University Third Hospital, Beijing, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya'an Zheng
- Emergency Department, Peking University Third Hospital, Beijing, China
| | - Rongchang Chen
- State Key Laboratory for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuguo Chen
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Institute of Emergency and Critical Care Medicine of Shandong University, Ji'nan, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yuqin Wang
- Pharmacy Department, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hongjun Zhang
- Departments of Nursing, Peking University Third Hospital, Beijing, China
| | - Yida Tang
- Department of Internal Medicine, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Qinglong Gu
- Department of Otolaryngology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Daihong Guo
- Pharmacy Department, Chinese PL A General Hospital, Beijing, China
| | - Xuehui Hu
- Department of Nursing, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lixin Xie
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Baohua Li
- Departments of Nursing, Peking University Third Hospital, Beijing, China
| | - Yuzhen Li
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Tongyu Lin
- State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fang Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lanting Lyu
- School of Public Administration and Policy, Renmin University of China, Beijing, China.,Health Technology Assessment and Health Policy Research Group at Renmin University of China, Beijing, China
| | - Quanxi Mei
- Department of Pharmacy, Shenzhen Bao'an Pure Chinese Medicine Treatment Hospital, Shenzhen, China
| | - Jie Shao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huawen Xin
- Department of Clinical Pharmacology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Fan Yang
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
| | - Hui Yang
- Departments of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wanhua Yang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xu Yao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
| | - Zhu Zhu
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Baoguo Zhou
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianqing Gu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mo Xian
- State Key Laboratory for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuan Lyu
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Institute of Emergency and Critical Care Medicine of Shandong University, Ji'nan, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Hangci Zheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,School of Pharmaceutical Science, Peking University, Beijing, China
| | - Chang Cui
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,School of Pharmaceutical Science, Peking University, Beijing, China
| | - Shuhua Deng
- Departments of Nursing, Peking University Third Hospital, Beijing, China
| | - Chao Huang
- National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Lisha Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengfei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,School of Pharmaceutical Science, Peking University, Beijing, China
| | - Chunli Shao
- Department of Internal Medicine, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sai Wang
- Pharmacy Department, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiang Ma
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Department of Physiology, Oklahoma University Health Science Center, Oklahoma City, OK, United States
| | - Qiang Wang
- National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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Barzegar S, Rosita A, Pourpak Z, Bemanian MH, Shokouhi R, Mansouri M, Cheraghi T, Chavoshzadeh Z, Mohammadzadeh I, Fazlollahi M, Mirsaeedghazi B, Nabavi M, Movahedi M, Gharagozlo M, Farahmand F, Moin M. Common causes of anaphylaxis in children: the first report of anaphylaxis registry in iran. World Allergy Organ J 2010; 3:9-13. [PMID: 23282381 PMCID: PMC3651078 DOI: 10.1097/wox.0b013e3181c82128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND : Anaphylaxis is an acute, systemic, and potentially fatal allergic reaction. Many things can cause anaphylaxis potentially but some agents are more common like some foods (milk, egg, soy, wheat, peanut, tree nut, shellfish, and fish), insect stings, medications, latex, and food-dependent exercise-induced anaphylaxis. The goal of this study is to show the common causes of anaphylaxis among the children with anaphylaxis history who were referred to the Immunology, Asthma and Allergy Research Institute (IAARI) during a 4-year period (2005-2009). METHODS AND MATERIALS : During those 4 years, we registered all children (<14 years old) with a history of anaphylactic reaction. To prove the cause of anaphylaxis, we performed skin prick tests with suspected agents according to their history and measured specific IgE against them by the ImmunoCAP test. Recognition of common allergens was based on having a positive history for 1 allergen and positive skin prick test or specific IgE for that at the same time, or having positive results from both tests when the allergen was unclear. Idiopathic anaphylaxis was a reaction when any known allergen and positive tests were not obtained. RESULTS : One hundred ninety-three nonfatal anaphylactic attacks among 63 children were recognized. In total, the most current cause of anaphylaxis in children was food (89.7%). Milk (49.3%) and wheat (26.1%) were the most common. Other foods were egg (8.7%), nuts (2.8%), and spices (2.8%). Six children (8.7%) were sensitive to multiple food allergens like milk, egg, and wheat. Five (7.1%) of 63 patients had anaphylactic attack because of stinging. Wasp was the trigger in 3 (4.3%) of them and honeybee was the cause in 1 (1.4%). The last one was because of unknown hymenoptera. There were 2 idiopathic cases of all 63 patients. CONCLUSIONS : Food allergens, especially milk and wheat, are the most common cause of anaphylaxis in children. Because anaphylaxis can be fatal, it is advisable to recognize its causes in different communities to prevent recurrent attacks.
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Affiliation(s)
- Saeideh Barzegar
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Akramian Rosita
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Zahra Pourpak
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mohammad Hassan Bemanian
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Raheleh Shokouhi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mahboubeh Mansouri
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Taher Cheraghi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Zahra Chavoshzadeh
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Iraj Mohammadzadeh
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mohammadreza Fazlollahi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Bahram Mirsaeedghazi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mohammad Nabavi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Masoud Movahedi
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mohammad Gharagozlo
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Fatemeh Farahmand
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
| | - Mostafa Moin
- The Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology and Allergy, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Shahid Sadoughi Hospital, Yazd University of Medical Sciences, Yazd, Iran; Immunology and Allergy Department, Mofid Children Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran; Children Research Institute, Babol University of Medical Sciences, Babol, Iran; Pediatric Department, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Department, Amirolmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran; Gastroenterology Department, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Supported by the Immunology, Asthma and Allergy Research Institute (IAARI) in Tehran, Iran
- Children's Medical Center, Immunology, Asthma and Allergy Research Institute, Keshavarz blvd, Dr Gharib ave, Tehran, Iran
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