Basophil Activation Test Reduces Oral Food Challenges to Nuts and Sesame

Abstract

What is already known about this topic? The introduction of nuts and seeds in the diet of children with 1 or more nut allergies is safe and feasible; however, because of polysensitization, this often requires multiple oral food challenges (OFCs).What does this article add to our knowledge? The basophil activation test (BAT), when used after skin prick and specific IgE testing, can reduce the number of OFCs, particularly positive OFCs, maintaining very high diagnostic accuracy.How does this study impact current management guidelines? In children with 1 or more nut allergies, needing an OFC to clarify the allergic status to other nuts, a positive BAT confirms allergy, whereas a negative BAT requires an OFC before recommending nut consumption or avoidance. BACKGROUND: Nut allergic patients are often IgE sensitized to other nuts/seeds and need multiple oral food challenges (OFCs) before the safe nuts can be introduced in the diet. However, OFCs are time-consuming and risky procedures.OBJECTIVE: To assess the utility of the basophil activation test (BAT) to predict the allergic status and reduce the need for an OFC in children with 1 or more nut or seed allergies. METHODS: Participants in the Pronuts study recruited at the Geneva and the London centers were tested on

The Basophil Activation Test for Clinical Management of Food Allergies: Recent Advances and Future Directions

“…The BAT has shown to be capable to discriminate between allergic and nonallergic children, to the respective nut/seed when tested against peanut, hazelnut, cashew nut, sesame, and almond. 32 Moreover, this study reported that the use of the BAT as a second step in the diagnostic process reduced the number of OFC by 5% to 15% after equivocal SPT and IgE to extracts and components. This notion was later reinforced by further studies showing that separately the SPT and the BAT were limited in their capacity to distinguish allergy from tolerance; however, when used in conjunction as part of the diagnostic kit their ability to identify allergic and tolerant patients improved.…”

Combinatorial advantage of Ses i 1‐specific IgE and basophil activation for diagnosis of sesame food allergy

“…13,23 This was supported by a recent publication investigating use of both sIgE and SPT, prior to BAT for equivocal cases. 10 In our current study, however, insofar as Ses i 1 IgE is utilized for strict ruling out of SFA, the majority of patients with bona fide suspected SFA would likely need a repeat blood draw, as BAT requires fresh blood for optimal performance. 24 The clinical role of a particular allergen component may be geographical and population-specific, but the demonstrated diagnostic efficacy of Ses i 1 in Japan, 6 United States, 7 and currently in Israel makes it likely to be a globally important determinant in sesame allergy.…”

“…Research, therefore, has focused on evaluating other diagnostic indicators such as sesame skin prick test (SPT) 3 especially those containing standardized high concentrations of allergen, 4,5 serum IgE against sesame components, 6,7 and basophil reactivity to sesame. 4,[8][9][10] BAT was previously validated for use for a variety of food allergens including peanut, 11 egg, 12 tree nuts, 13 milk, 14 and sesame. 4,[8][9][10] Receiver operating characteristic (ROC) curve analysis of these tests has provided diagnostic accuracy levels of 0.77-0.86 for high-protein concentration SPT, 4,5 0.72-0.82 for Ses i 1, 6,7 and 0.86 for CD63-induced expression on basophils.…”

“…4,[8][9][10] BAT was previously validated for use for a variety of food allergens including peanut, 11 egg, 12 tree nuts, 13 milk, 14 and sesame. 4,[8][9][10] Receiver operating characteristic (ROC) curve analysis of these tests has provided diagnostic accuracy levels of 0.77-0.86 for high-protein concentration SPT, 4,5 0.72-0.82 for Ses i 1, 6,7 and 0.86 for CD63-induced expression on basophils. 4 Despite the utility of the above tests to significantly distinguish between allergic and tolerant groups, each of them alone does not have both a high enough sensitivity and specificity to confirm or exclude food allergy with sufficient certainty to obviate the need to perform an OFC.…”

Modern Principles of Managing Children with Food Allergies

“…В сомнительных случаях с диагностической целью необходимо рассмотреть проведение клеточных тестов -исследование активации базофилов [30][31][32].…”