Cardiovascular changes during peanut-induced allergic reactions in human subjects

Ruíz-García, Mónica; Bartra, Joan; Alvarez, Olaya; Lakhani, Ashna; Patel, S; Tang, Alistair; Sim, Marcus; Shamji, Mohamed H.; Skypala, Isabel; Mills, E. N. Clare; Lyon, Alexander R.; Hayward, Carl; Durham, Stephen R.; Turner, Paul J.; Boyle, Robert

doi:10.1016/j.jaci.2020.06.033

Cited by 42 publications

(32 citation statements)

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“…For example, the allergic reaction may have caused a disturbance in normal postural circulatory reflexes, akin to the blunting of postural reflexes which is often observed during anaesthesia 19 . Orthostatic hypotension is associated with a decrease in heart rate variability, 20,21 and previous studies in both children and adults have reported reduced heart rate variability following food‐induced allergic reactions, independent of severity 18,22 . Thus, these episodes could potentially represent a more mild form of the postural decompensation seen in some cases of fatal anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Delayed symptoms and orthostatic intolerance following peanut challenge

Turner

Ruíz-García

Patel

et al. 2021

Clin Experimental Allergy

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Section: Discussionmentioning

confidence: 99%

Delayed symptoms and orthostatic intolerance following peanut challenge

Turner

Ruíz-García

Patel

et al. 2021

Clin Experimental Allergy

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“…Food-allergic patients present with a marked diversity by reactivity profiles ( 15 ). Clinical symptoms range from mild to severe (severity score) as does eliciting doses (sensitivity score) and time to reaction onset are highly variable ( 16 , 17 ). The estimated dose likely to trigger reactions in 10% of a study population (ED 10 ) vary also for specific foods (eg, peanut 11 mg; shrimp 12.8 g protein) ( 18 ).…”

Section: Type-i Hypersensitivity To Foodmentioning

confidence: 99%

IgE-Mediated Peanut Allergy: Current and Novel Predictive Biomarkers for Clinical Phenotypes Using Multi-Omics Approaches

et al. 2021

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Food allergy is a collective term for several immune-mediated responses to food. IgE-mediated food allergy is the best-known subtype. The patients present with a marked diversity of clinical profiles including symptomatic manifestations, threshold reactivity and reaction kinetics. In-vitro predictors of these clinical phenotypes are evasive and considered as knowledge gaps in food allergy diagnosis and risk management. Peanut allergy is a relevant disease model where pioneer discoveries were made in diagnosis, immunotherapy and prevention. This review provides an overview on the immune basis for phenotype variations in peanut-allergic individuals, in the light of future patient stratification along emerging omic-areas. Beyond specific IgE-signatures and basophil reactivity profiles with established correlation to clinical outcome, allergenomics, mass spectrometric resolution of peripheral allergen tracing, might be a fundamental approach to understand disease pathophysiology underlying biomarker discovery. Deep immune phenotyping is thought to reveal differential cell responses but also, gene expression and gene methylation profiles (eg, peanut severity genes) are promising areas for biomarker research. Finally, the study of microbiome-host interactions with a focus on the immune system modulation might hold the key to understand tissue-specific responses and symptoms. The immune mechanism underlying acute food-allergic events remains elusive until today. Deciphering this immunological response shall enable to identify novel biomarker for stratification of patients into reaction endotypes. The availability of powerful multi-omics technologies, together with integrated data analysis, network-based approaches and unbiased machine learning holds out the prospect of providing clinically useful biomarkers or biomarker signatures being predictive for reaction phenotypes.

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“…Effective adrenaline causes vasoconstriction and bronchodilation, increases myocardial contractility and inhibits mast cell degranulation 3 . Plasma extravasation equivalent to one third of the circulating blood volume can occur within minutes in severe reactions 5 ; however, venous return is significantly compromised even in those without overt haemodynamic compromise 6 . Intravenous fluid support is therefore necessary, both to treat shock and to maintain adequate circulatory volume to optimize adrenaline delivery.…”

Section: Figurementioning

confidence: 99%

Refractory anaphylaxis: Treatment algorithm

Sargant

Dodd

Hughes

et al. 2021

Allergy

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There is no established definition for refractory anaphylaxis. The European Anaphylaxis Registry use a definition of "anaphylaxis which, despite treatment with at least two doses of minimum 300 μg adrenaline, does not achieve normalization" of symptoms. 1 A US-based panel recently proposed a reaction which "must be treated with 3+ appropriate doses of epinephrine (or initiation of an intravenous epinephrine infusion)" 2 -a definition which does not specifically refer to treatment response, although this is implied. The Resuscitation Council UK (RCUK) recently updated its guideline on the emergency treatment of anaphylaxis, defining refractory anaphylaxis as a reaction "requiring ongoing treatment despite two (appropriate) doses of intramuscular adrenaline" and proposes an algorithm to facilitate management (Figure 1). 3Refractory anaphylaxis is rare: the European Registry reported a rate of 0.37% of all anaphylaxis cases reported in the registry, with

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Cardiovascular changes during peanut-induced allergic reactions in human subjects

Cited by 42 publications

References 31 publications

Delayed symptoms and orthostatic intolerance following peanut challenge

Delayed symptoms and orthostatic intolerance following peanut challenge

IgE-Mediated Peanut Allergy: Current and Novel Predictive Biomarkers for Clinical Phenotypes Using Multi-Omics Approaches

Refractory anaphylaxis: Treatment algorithm

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