Anaphylactic Reaction to Bee Stings in the Rural Areas of Gorgan City: Iran’s First Epidemiological Study of Hymenoptera-Induced Anaphylaxis

We aimed to determine the epidemiology of anaphylaxis to bee stings in the rural areas of Gorgan City, Iran.  Anaphylaxis is a severe, life-threatening, diffuse or systemic hypersensitivity reaction with rapidly progressive problems such as airway (throat or laryngeal edema) or bronchospasm, tachypnea and hypotension .The systemic response to bee stings is 1% in children and 3% in adults. Anaphylaxis due to bee stings is very dangerous in many cases, and may even be fatal at the initial stage. In this cross-sectional study, we analyzed some of the epidemiological characteristics of the study participants, such as demographic information, bee type, the cause of anaphylaxis, the time of bee sting, the onset of symptoms of anaphylaxis after a bee sting, the number of bee stings, symptoms during anaphylaxis, and therapeutic and prophylactic measures. In total, 201 patients were diagnosed with anaphylaxis caused by bee stings. Of these, 129(64%) were male, and 72(36%) were female with the Mean±SD age of 34.33±32 and 35.25±34 years, respectively. Anaphylaxis incidents occurred in 108 men, and 103 women out of 100000; 169 of whom were adults and 46 were children. Anaphylaxis occurred in 105(52.2%) cases in <5 minutes after being stung (very severe attack) and in 94(46.8%) cases, between 5-60 minutes after being stung (rapid attack) (P=0.45). The patients’ involved organs were skin (85.6%), respiratory system (78.6%), cardiovascular system (35.8%), nervous system (17.4%), and gastrointestinal tract (10.9%). Among these stings, 78(38.8%), 107(53.2%), and 16(8%) occurred indoors, outdoors, and at home, respectively (P=0.05). 7(9.5%) children and 67(39.6%) adults had hypotensive symptoms (P=0.05). Ninety five percent of cases have been stung for <10 times, and 80% of those who have experienced more than 10 stings experienced severe anaphylactic attacks (P=0.003). Case finding was successful through the rural health network. To obtain accurate epidemiological data on the prevalence of anaphylaxis due to bee stings, an anaphylaxis registry and healthcare service packages are recommended. In this integrated model, a service package, including raising awareness and the knowledge of people, and treatment for anaphylaxis can be employed.