Cardiovascular changes during peanut-induced allergic reactions in human subjects

作者：Mónica Ruiz-García, Joan Bartra, Olaya Alvarez, Ashna Lakhani, S Patel, Alistair Tang, Marcus Sim, Mohamed H. Shamji, Isabel Skypala, E. N. Clare Mills, Alexander R Lyon, Carl Hayward, Stephen R. Durham, Paul Turner, Robert Boyle · 发表于：Journal of Allergy and Clinical Immunology · 年份：2020 · DOI：10.1016/j.jaci.2020.06.033 · 被引用次数：60 · 研究领域：Food Allergy and Anaphylaxis Research、Contact Dermatitis and Allergies、Fibromyalgia and Chronic Fatigue Syndrome Research

BACKGROUND: Food allergy is the most common cause of anaphylaxis. Changes in posture during acute reactions can trigger fatal outcomes, but the impact of allergic reactions on the cardiovascular system in nonfatal reactions remains poorly understood. OBJECTIVE: Our aim was to systematically evaluate changes in cardiovascular function during acute allergic reactions to peanut. METHODS: Participants underwent double-blind placebo-controlled food challenge to peanut as part of a clinical trial. Changes in hemodynamic parameters (heart rate, stroke volume, blood pressure, and peripheral blood flow) and electrocardiogram findings during food challenges were assessed using noninvasive continuous monitoring. RESULTS: A total of 57 adults (median age 24 years [interquartile range = 20-29]), 53% of whom were female, participated; 22 (39%) had anaphylaxis. Acute reactions were associated with significant changes in stroke volume (mean decrease of 4.2% [95% CI = 0.8-7.6; P = .03]), heart rate (mean increase 11.6% [95% CI = 8.4-14.8; P < .0001]), and peripheral blood flow (mean increase 19.7% [95% CI = 10.8-28.6; P < .0001]), irrespective of reaction severity. These changes were reproduced at a subsequent repeat peanut challenge in 26 participants, and could be reversed with administration of intravenous fluids which resulted in faster resolution of abdominal symptoms. CONCLUSIONS: In this first detailed human study of cardiovascular changes during food-induced allergic reactions, we fou...