Diagnosis of Immediate-Type ß-Lactam Allergy In Vitro by Flow-Cytometric Basophil Activation Test and Sulfi doleukotriene Production: A Multicenter Study
AL De Weck (1), ML Sanz (1), PM Gamboa (2), W Aberer (3), G Sturm (3), MB Bilo (4), M Montroni (4), M Blanca (5), MJ Torres (5), L Mayorga (5), P Campi (6), M Manfredi (6), M Drouet (7), J Sainte-Laudy (8), A Romano (9), H Merk (10), JM Weber (11), TM Jermann (11) and members of ENDA (European Network for Drug Allergy)
(1) Department of Allergology and Clinical Immunology, University of Navarra, Collaborative Center of GA2LEN, Pamplona, Spain
(2) Allergy Division, Hospital Basurto, Bilbao, Spain
(3) Department of Dermatology, University of Graz, Graz, Austria
(4) University Hospital, Ancona, Italy
(5) Hospital Haya, Malaga, Spain
(6) University Hospital, Florence, Italy
(7) Centre Hospitalier Universitaire, Angers, France
(8) Centre Hospitalier Universitaire, Limoges, France
(9) Allergy Unit, Complesso Integrato Columbus, Rome, Italy
(10) Dermatology Clinic, University Hospital, Aachen, Germany
(11) Bühlmann Laboratories AG, Allschwil, Switzerland
Magazine: Journal of Investigational Allergology and Clinical Immunology
Date: Aug 1, 2009Allergology and Immunology Department
This multicenter study aimed to evaluate the diagnostic value of 2 cellular tests based on basophil reactivity—the basophil activation test (BAT, Flow-CAST) and the sulfi doleukotriene release assay (CAST-ELISA)—in immediate-type ß-lactam allergy, particularly in patients with a clinical history of allergy and a negative skin test result.
Material and Methods
In a multicenter study encompassing 10 European centers, 181 patients with a history of immediate-type ß-lactam allergy, and 81 controls, we evaluated the diagnostic effi ciency of specifi c IgE determinations and of 2 cellular tests based on basophil reactivity, the BAT and the sulfidoleukotriene release assay.
With Flow-CAST, sensitivity varied for individual ß-lactam allergens from 16% for penicilloyl-polylysine to 33% for amoxicillin, reaching 50% when all 5 allergens were considered. In ß-lactam–allergic patients with negative skin test results (22.8%), Flow-CAST showed positive results for at least 1 of the 5 allergens in 37%. Specifi city varied from 89% to 97%, depending on the allergens used. In CAST-ELISA, the overall sensitivity in skin test–positive patients was 41.7%; in patients with negative skin test results it was 27.9%.
Both tests were not absolutely correlated, so that when all the results were considered together, sensitivity increased to 64.3% and specifi city varied for both tests combined from 73% to 92%. In contrast, specifi c IgE determinations in the same population yielded a lower sensitivity (28.3%).
A diagnostic algorithm including skin tests and specifi c IgE, followed by cellular tests in negative patients and controlled challenge enabled us to confi rm ß-lactam allergy in 92% of cases. This procedure would also allow us to avoid two-thirds of the required controlled challenges.
CITATION J Investig Allergol Clin Immunol. 2009;19(2):91-109
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