Cardiovascular changes during peanut-induced allergic reactions in human subjects

被引：44

作者：

Ruiz-Garcia, Monica ^{[1
]}

Bartra, Joan ^{[1
,3
]}

Alvarez, Olaya ^{[1
]}

Lakhani, Ashna ^{[1
]}

Patel, Shalinee ^{[1
]}

Tang, Alistair ^{[1
]}

Sim, Marcus ^{[1
]}

Shamji, Mohamed H. ^{[1
]}

Skypala, Isabel ^{[1
,5
]}

Mills, E. N. Clare ^{[6
]}

Lyon, Alexander R. ^{[2
,4
]}

Hayward, Carl ^{[2
,4
,7
]}

Durham, Stephen R. ^{[1
,5
]}

Turner, Paul J. ^{[1
]}

Boyle, Robert J. ^{[1
]}

机构：

[1] Imperial Coll London, Natl Heart & Lung Inst, Sect Inflammat Repair & Dev, Norfolk Pl, London W2 1PG, England

[2] Imperial Coll London, Natl Heart & Lung Inst, Myocardial Funct, London, England

[3] Hosp Clin Barcelona, Barcelona, Spain

[4] Cardiol Dept, London, England

[5] Royal Brompton & Harefield Hosp NHS Fdn Trust, London, England

[6] Univ Manchester, Sch Biol Sci, Div Infect Immun & Resp Med, Manchester, Lancs, England

[7] Barts Hlth NHS Trust, London, England

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY | 2021年 / 147卷 / 02期

基金：

英国医学研究理事会;

关键词：

Anaphylaxis; cardiac output; cardiovascular; food allergens; intravenous fluids; management; stroke volume; venous return; ANAPHYLACTIC SHOCK; PATHOPHYSIOLOGY; HEMODYNAMICS; GUIDELINES; MANAGEMENT;

D O I：

10.1016/j.jaci.2020.06.033

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

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 5 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 found evidence for significant fluid redistribution, independent of reaction severity. This provides a sound rationale for optimizing venous return during significant allergic reactions to food. Finally, these data provide a new paradigm for understanding severity in anaphylaxis, in which poor outcomes may occur as a result of a failure in compensatory mechanisms.

引用

页码：633 / 642

页数：10

共 31 条

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