Clinical Routine Utility of Basophil Activation Testing for Diagnosis of Hymenoptera-Allergic Patients with Emphasis on Individuals with Negative Venom-Specific IgE Antibodies

Abstract

Background: Previous reports suggest the usefulness of basophil activation testing (BAT) in Hymenoptera-allergic patients with negative venom-specific IgE antibodies. We sought to evaluate the diagnostic utility of this testing in a routine clinical laboratory setting. Materials and Methods: Twenty-one patients with anaphylactic reactions to Hymenoptera sting (median grade III) and negative venom-specific IgE were routinely and prospectively tested with BAT. Results: We were able to diagnose 81% (17 of 21) of patients with BAT and 57% (12 of 21) with intradermal skin testing. Three wasp venom-allergic patients showed IgE positivity to rVes v 5. Four patients (19%) were negative for all tests. In the case of double-positive BAT, the culprit insect correlated with the venom that induced a significantly higher basophil response. Conclusions: BAT allows the identification of severe Hymenoptera-allergic patients with negative specific IgE and skin tests. The routine use of this cellular test should facilitate prescription of venom immunotherapy in complex cases with inconclusive diagnostic results.

Follow-Up of Venom Immunotherapy on Flow Cytometry and Definition of a Protective Index

“…In the field of venom allergy diagnosis, basophil activation measured by flow cytometry has been the aim of a lot of papers dealing both with venom allergy diagnosis and venom immunotherapy (VIT) follow-up [2,5,6,7,8]. …”

News in Cellular Allergology: A Review of the Human Mast Cell and Basophil Granulocyte Literature from January 2013 to May 2015

“…The identity of sensitising insects in patients with hymenoptera venom allergy but without s-IgE to venoms could be determined with BAT [70]. In a head-to-head comparison, CRD (component-resolved diagnosis) could not completely replace BAT in the diagnosis of Vespula vulgaris venom allergy in patients negative for other first-line tests [71].…”

Immunotherapy in allergy and cellular tests

“…22,40 Most of recent BATs were performed in Hymenoptera venom AIT. 51,52 During Hymenoptera venom immunotherapy (VIT) a rise in CD63 was previously reported. 187 The increase in CD63 membrane expression during VIT indicates a partial basophil degranulation with release of stored protein mediators, including IL-4, a cytokine that may cause in turn a transient upregulation of different surface antigens in an autocrine manner.…”

“…[52][53][54] Basophils might exert a quite different task in progressing the hypersensitivity reaction than mast cells and eosinophils, as probably they play a modulating and regulating action in allergy rather than ruling an effector mechanism. 55 Both the innate and acquired immune networks play an outstanding role in AIT but may hinder a full comprehension of which role basophils exert in the field.…”