Imperial College London
Portrait Picture

ProfessorStephenDurham

Faculty of Medicine, National Heart & Lung Institute

Professor of Allergy and Respiratory
 
 
 
//

Contact

 

+44 (0)20 7351 8024s.durham

 
 
//

Location

 

Fulham RoadRoyal Brompton Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Ruiz-Garcia:2021:10.1016/j.jaci.2020.06.033,
author = {Ruiz-Garcia, M and Bartra, J and Alvarez, O and Lakhani, A and Patel, S and Tang, A and Sim, M and Shamji, MH and Skypala, I and Mills, ENC and Lyon, AR and Hayward, C and Durham, SR and Turner, PJ and Boyle, RJ},
doi = {10.1016/j.jaci.2020.06.033},
journal = {Journal of Allergy and Clinical Immunology},
pages = {633--642},
title = {Cardiovascular changes during peanut-induced allergic reactions in human subjects},
url = {http://dx.doi.org/10.1016/j.jaci.2020.06.033},
volume = {147},
year = {2021}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Food allergy is the commonest cause of anaphylaxis. Changes in posture during acute reactions can trigger fatal outcomes, but the impact of allergic reactions on the cardiovascular system in non-fatal reactions remains poorly understood. Objective: To systematically evaluate changes in cardiovascular function during acute allergic reactions to peanut. Methods: Participants underwent double-blind placebo-controlled food challenge topeanut as part of a clinical trial. Changes in hemodynamic parameters (heart rate, stroke volume, blood pressure, peripheral blood flow) and electrocardiogram during food challenges were assessed using continuous monitoring. ClinicalTrials.gov Identifier: NCT02665793 Results: 57 adults (median age 24 (IQR 20-29) years, 53% female) participated; 22 (39%) had anaphylaxis. Acute reactions were associated with significant changes in stroke volume (mean decrease 4.2%, 95%CI 0.8 to 7.6; p=0.03), heart rate (mean increase 11.6%, 95%CI 8.4 to 14.8; p<0.0001) and peripheral blood flow (mean increase 19.7%, 95%CI 10.8 to 28.6; p<0.0001), irrespective of reaction severity. These changes were reproduced at 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-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, where poor outcomes occur due to a failure in compensatory mechanisms.Ruiz-Garcia et al 5 Clinical Implication: Significant changes in cardiovascular function, including decreased stroke volume, occur during peanut-induced allergic reactions in adults irrespective of severit
AU  - Ruiz-Garcia,M
AU  - Bartra,J
AU  - Alvarez,O
AU  - Lakhani,A
AU  - Patel,S
AU  - Tang,A
AU  - Sim,M
AU  - Shamji,MH
AU  - Skypala,I
AU  - Mills,ENC
AU  - Lyon,AR
AU  - Hayward,C
AU  - Durham,SR
AU  - Turner,PJ
AU  - Boyle,RJ
DO  - 10.1016/j.jaci.2020.06.033
EP  - 642
PY  - 2021///
SN  - 0091-6749
SP  - 633
TI  - Cardiovascular changes during peanut-induced allergic reactions in human subjects
T2  - Journal of Allergy and Clinical Immunology
UR  - http://dx.doi.org/10.1016/j.jaci.2020.06.033
UR  - http://hdl.handle.net/10044/1/80940
VL  - 147
ER  -
Download