Physicians predominantly rely upon quantification of serum‐specific immunoglobulin E (IgE) and/or skin test to confirm clinically suspected IgE‐mediated allergy. However, for various reasons, identification of the offending allergen(s) and potentially cross‐reactive structures is not always straightforward. Flow‐assisted allergy diagnosis relies upon quantification of alterations in the expression of particular basophilic activation markers. Actually, upon challenge with a specific allergen, basophils not only secrete quantifiable bioactive mediators but also upregulate the expression of different markers which can be detected efficiently by flow cytometry using specific monoclonal antibodies. Currently, the technique has been applied in the investigation of IgE‐mediated allergy caused by classical inhalant allergens, food, Hevea latex, hymenoptera venoms and drugs. It is also appreciated; the technique proves valuable in the diagnosis of non‐IgE‐mediated (anaphylactoid) reactions such drug hypersensitivity and the detection of autoantibodies in certain forms of chronic urticaria. This review will not address immunologic features, characteristics and general pitfalls of flow‐assisted analysis of in vitro‐activated basophils as summarized elsewhere. After a recapitulation of the principles and some specific technical issues of flow‐assisted analysis of in vitro‐activated basophils, we principally focus on the current clinical and research applications of the basophil activation tests. Personal experience of both research groups is provided, where appropriate. Finally, a viewpoint on how the field might evolve in the following years is provided.

The BAT constitutes a reliable instrument to diagnose anaphylaxis from rocuronium. The technique also allows quick and simultaneous testing of different potential cross-reactive NMBA and to tailor a safe alternative.

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BACKGROUNDCannabis allergy (CA) has mainly been attributed to Can s 3, the nsLTP (non-specific lipid transfer proten) of Cannabis sativa. Nevertheless, standardized diagnostic tests are lacking and research on CA is scarce. OBJECTIVETo explore the performance of five cannabis diagnostic tests and the phenotypic profile of CA. METHODS120 CA patients were included and stratified according to the nature of their cannabis-related symptoms, 62 healthy and 189 atopic controls were included. Specific (s)IgE hemp, sIgE and BAT rCan s 3, BAT with a crude cannabis extract and a skin prick test (SPT) with a nCan s 3-rich cannabis extract were performed. Clinical information was based on patient-history and a standardized questionnaire. RESULTSFirstly, up to 72% of CA reporting likely-anaphylaxis (CA-A) are Can s 3 sensitized. Actually, the Can s 3-based diagnostic tests show the best combination of positive and negative predictive values; 80% and 60%, respectively. sIgE hemp displays 82% sensitivity but only 32% specificity. Secondly, Can s 3+CA reported significantly more cofactor mediated reactions and displayed significantly more sensitizations to other nsLTPs than Can s 3-CA. Finally, the highest prevalence of systemic reactions to plant-derived foods was seen in CA-A, namely 72%.