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Heart Rate Variability Patterns Differentiate Between Positive and Negative Oral Food Challenges in Children With
Naama Epstein-Rigbi1, Yael Koren2, Limor Ben-Nun Toledano3
1Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, School of Medicine, Tel Aviv University, Tel Aviv, Israel; Allergy and Immunology Unit, Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University, Be'er Sheva, Israel.
Insights
Heart rate variability (HRV) patterns can distinguish between true allergic reactions and subjective symptoms during oral food challenges (OFCs). This objective measure may aid in diagnosing food allergies more accurately.
Area of Science:
- Pediatric Allergy and Immunology
- Cardiology
- Biomedical Engineering
Background:
- Oral food challenges (OFCs) can yield ambiguous results due to subjective complaints or mild symptoms.
- Differentiating objective allergic reactions from non-allergic responses in OFCs is clinically challenging.
Purpose of the Study:
- To determine if heart rate variability (HRV) patterns can differentiate children with objective allergic reactions from those without during OFCs.
- To explore HRV as a potential objective tool for OFC interpretation.
Main Methods:
- A comparative cohort study analyzed HRV patterns in 104 pediatric patients undergoing OFCs.
- Heart rate was continuously monitored using a smart wristband device.
- The modified cardiac sympathetic index (CSI) was used to compare HRV patterns between groups.
Main Results:
- HRV patterns significantly differed between positive (allergic) and negative (non-allergic) OFCs (p<0.001).
- Lower modified CSI scores were observed in patients with subjective complaints and negative OFCs compared to those with positive OFCs (p=0.005).
- Higher modified CSI scores were found in the positive OFC cohort when perioral rash was present (p<0.001).
Conclusions:
- HRV patterns effectively differentiate between positive and negative OFCs, independent of subjective symptoms.
- HRV monitoring shows promise as an objective adjunctive tool for interpreting OFC results.
- Further research could validate HRV for improved accuracy in diagnosing food allergies.
Background:
Subjective complaints as well as mild symptoms during oral food challenges (OFCs) present a clinical dilemma and may result in false-positive OFCs.
Objective:
To examine whether heart rate variability (HRV) patterns can help differentiate between patients with and without an objective allergic reaction during an OFC.
Methods:
In this comparative cohort study, we examined the HRV patterns of children undergoing OFCs using a smart wristband device that continuously measured heart rate values. Comparison between cohorts was performed retrospectively using the derivative modified cardiac sympathetic index (CSI).
Results:
Data from 104 pediatric patients were analyzed. Of these, 57 had a positive OFC (developed an allergic reaction), whereas 47 had a negative OFC. The baseline modified CSI scores (pre-OFC) were comparable between patients from both cohorts (P = .48). The HRV patterns throughout the OFCs were significantly different between positive and negative challenges (P < .001). Patients with subjective complaints who had a negative OFC had a significantly lower modified CSI compared with patients with a positive challenge (P = .005). The scores of positive OFCs were not affected by reaction severity as measured by the Sampson score (Sampson score 2 vs Sampson scores 3 and 4) (P = .93). When comparing patients with a perioral rash with a positive versus a negative OFC, there were significantly higher scores in the positive OFC cohort (P < .001).
Conclusions:
HRV patterns differentiate between positive and negative OFCs, regardless of the presence of subjective complaints. With further investigation, HRV monitoring may have the potential to serve as an objective adjunctive tool.
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