Heart rate variability patterns differentiate between positive and negative oral food challenges in children with food allergy.

Authors

Naama Epstein-Rigbi, Yael Koren, Limor Ben-Nun Toledano, Rotem Blauground, Matan Elkan, Liat Nachshon, Arnon Elizur, Itamar Noham

Published in

The journal of allergy and clinical immunology. In practice. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

Subjective complaints as well as mild symptoms during oral food challenges (OFCs) present a clinical dilemma and may result in false positive OFCs.
To examine whether heart rate variability (HRV) patterns can help differentiate between patients with and without an objective allergic reaction during an OFC.
In this comparative cohort study we examined the HRV patterns of children undergoing OFCs using a smart wristband device which continuously measured heart rate values. Comparison between cohorts was done retrospectively using the derivative modified cardiac sympathetic index (CSI).
Data of 104 pediatric patients were analyzed. 57 had a positive OFC (developed an allergic reaction) while 47 had a negative OFC. The baseline modified CSI scores (pre-OFC) were comparable between patients from both cohorts, p=0.48. The HRV patterns throughout the OFCs were significantly different between positive and negative challenges, p<0.001. Patients with subjective complaints who had a negative OFC had a significantly lower modified CSI compared to patients with a positive challenge, p=0.005. The scores of positive OFCs were not affected by reaction severity as measured by Sampson score (Sampson 2 vs Sampson 3,4), p= 0.93. When comparing patients with a perioral rash with a positive vs a negative OFC, there were significantly higher scores in the positive OFC cohort, p<0.001.
HRV patterns differentiate between positive versus 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.

PMID:
42600983
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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