The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease
Hoffmann HJ (1), Santos AF (2,3,4), Mayorga C (5), Nopp A (6), Eberlein B (7), Ferrer M (8), Rouzaire P (9), Ebo DG (10), Sabato V (10), Sanz ML (8), Pecaric-Petkovic T (11), Patil SU (12), Hausmann OV (13,14), Shreffler WG (12), Korosec P (15), Knol EF (16).
(1) Department of Respiratory Diseases and Allergy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
(2) Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
(3) MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
(4) Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal.
(5) Research Laboratory and Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain.
(6) Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
(7) Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany.
(8) Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain.
(9) Department of Immunology, University Hospital, Clermont-Ferrand and ERTICa Research Group, University of Auvergne, Clermont-Ferrand, France.
(10) Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
(11) Adverse Drug Reactions-Analysis and Consulting (ADR-AC) GmbH, Bern, Switzerland.
(12) Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
(13) Department of Rheumatology, Immunology and Allergology, Inselspital, University of Bern, Bern, Switzerland.
(14) Loewenpraxis, Luzern, Switzerland.
(15) Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
(16) Department of Immunology and Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
The basophil activation test (BAT) has become a pervasive test for allergic response through the development of flow cytometry, discovery of activation markers such as CD63 and unique markers identifying basophil granulocytes.
Basophil activation test measures basophil response to allergen cross-linking IgE on between 150 and 2000 basophil granulocytes in <0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils.
In addition to clinical history, skin prick test, and specific IgE determination, BAT can be a part of the diagnostic evaluation of patients with food-, insect venom-, and drug allergy and chronic urticaria. It may be helpful in determining the clinically relevant allergen.
Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment or in the natural resolution of allergy. Basophil activation test may use fewer resources and be more reproducible than challenge testing. As it is less stressful for the patient and avoids severe allergic reactions, BAT ought to precede challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories.
The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. In this EAACI task force position paper, we provide an overview of the practical and technical details as well as the clinical utility of BAT in diagnosis and management of allergic diseases.
CITATION Allergy. 2015 Nov;70(11):1393-405. doi: 10.1111/all.12698. Epub 2015 Sep 8