Basophil activation test for the in vitro diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity

Abstract

There is need for an in vitro diagnostic test for hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). The purpose of this study was to assess the reliability of one such diagnostic, the basophil activation test. Forty-three drug hypersensitive patients referring several immediate reactions (anaphylaxis, urticaria, angioedema, asthma, and rhinoconjunctivitis) to one or more NSAIDs and 29 controls participated. Using the Basotest commercial kit, 63 determinations were performed with the drugs implicated in the adverse reactions (ASA, ibuprofen, metamizol, diclofenac, paracetamol, and ketorolac). In 16 patients additional determinations were made with other chemically unrelated NSAIDs. Forty-two determinations were made for controls. The analysis was performed by flow colorimetric cytometry and double staining with the monoclonal antibodies anti-IgE and anti-CD63. A Basophil Activation Index (percentage of activated basophils after allergen stimulation/percentage of basally activated basophils) of two or more was considered a positive result. Specificity of 100% and sensitivity of 42.85% were achieved. The positive predictive value was 100%, and the negative predictive value was 53.84%. In 35.29% of intolerant patients there was a positive reaction to at least two drugs implicated in adverse reactions, and in 27.27% of these patients there was a positive reaction to other chemically unrelated NSAIDs. The basophil activation test is useful for the in vitro diagnosis of NSAID hypersensitivity, providing good specificity and positive predictive value and diagnostic reliability in the assessment of NSAID intolerance.

Basophil Responsiveness and Clinical Picture of Acetylsalicylic Acid Intolerance

“…This test is based on ASA-induced activation of basophils, followed by the measurement of the abundance of the CD63 surface marker. The results of previous publications conflict with those of some authors showing that ASA basophil testing is useful [14,15,16,17] and others showing that it is not [18,19]. Because of these conflicting results, we conducted a prospective single-blind study to evaluate the specificity of basophil responsiveness to ASA, as well as to diagnostically compare these results between clinically different patients and matched tolerant subjects.…”

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…18,19 CD203c can be rapidly measured by flow cytometry and has been proposed as a diagnostic tool in atopic disease, including peanut, drug and wasp venom allergy. [20][21][22] It has been shown that basophils are primed and hyper-responsive to Af allergen stimulation in CF-ABPA. 18 In this current study, BAT to Af was employed to identify Af sensitization in a CF cohort and it was correlated with key CF clinical measurements.…”

Basophil Activation Test in Allergy: Time for an Update?

“…Based on the receiver operating characteristics-generated cutoff value of 17% for CD63-positive basophils, as captured by the usual anti-IgE-FITC method, Ebo et al [43] estimated a BAT sensitivity and specificity of 93.1 and 91.7%, respectively, as evaluated in a population of subjects allergic to latex, encouraging results that were then confirmed in subsequent reports by others [44]. Several reviews about this promising test began to appear, aimed at achieving possible acceptance while describing the state of the art of its application in allergy diagnosis [45,46,47,48,49,50,51], issues that are still being faced nowadays [52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74]. However, despite promising initial studies and some encouraging evidence, many authors agreed that CD63-based BAT remained disappointing in terms of sensitivity, while CD203c-based BAT showed a higher sensitivity (75 vs. 50%), though not as exciting as some reports suggested [39].…”