Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate‐type reactions to betalactam antibiotics

Sánz, M L; Gamboa, P. M.; Antépara, I.; Uasuf, Carina Gabriela; Vila, Leticia; García-Avilés, C; Chazot, M.; Weck, A.L. de

doi:10.1046/j.1365-2222.2002.01305.x

Cited by 234 publications

(194 citation statements)

References 18 publications

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“…The first studies using the basophil activation test to analyze βlactam allergy reported a sensitivity of 50% in patients who tested positive for at least 1 penicillin in a skin test and a specificity of 93%. 59,60 Similar data were obtained in a multicenter study, 61 which re ported a sensitivity of 50% and a specificity be tween 89% and 97%, and emphasized the need to test more than 1 βlactam at a minimum of 2 concentrations to obtain optimal results.…”

Section: Immediate or Immunoglobulin-e-mediated Reac-supporting

confidence: 59%

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Moreno¹,

Laffond²,

Muñoz-Bellido³

et al. 2017

Polish Archives of Internal Medicine

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ABSTRACTβ-lactams are the most widely used antibiotic family, but they are also the most common cause of drug-induced hypersensitivity reactions. The estimated prevalence of reported penicillin allergy ranges between 9% and 12%, although a high percentage of patients with a history of penicillin allergy have no subsequent reactions on reexposure to β-lactams. A self-reported penicillin allergy has been associated with antimicrobial resistance, increased cost, intensive care admission, and death, making it essential to establish an accurate diagnosis. In addition to a thorough clinical history, diagnostic methods include skin tests, in vitro tests, and drug-challenge tests. In this review, the diagnosis and management of patients with self-reported penicillin allergy is discussed, including the recently introduced antimicrobial stewardship strategy.REVIEW ARTICLE Use of β-lactam antibiotics in patients with a history of β-lactam allergy 541Antigenic determinants of β-lactams Penicillins and βlactams are generally considered immuno logically haptens and need to bind to carrier mol ecules to acquire complete immunogenic poten cy. The binding of the antibiotic to amino groups of autologous proteins induces a conformational modification that causes the immune system to recognize them as strange. The βlactam rings and the side group are all potentially immunogenic.Penicillins have been the most studied antibiot ics. The βlactam ring is intrinsically reactive and does not need prior metabolism. The instability of its structure makes it open quickly, allowing the carbonyl groups to form amidetype linkages with the amino groups of the lysine residues of the nearby proteins. 26 As approximately 95% of the penicillin molecules are bound to proteins in this manner, the antigenic determinant formed, benzylpenicilloyl (BPO), has been known as the major antigenic determinant of penicillin. BPO has been attached to a weakly immunogenic car rier molecule, called polylysine, to form benzyl penicilloyl polylysine (BPOPPL), which is used in making skin tests. The remaining part of the penicillin molecule degrades to a range of deriv atives which can also act as haptens. 27 These are minor determinants accounting for allergic reac tions in approximately 10% to 20% of patients. 23 The minor determinant mixture (MDM) has been also used in skin tests.The progressive increase in the consumption of amoxicillin (AX) has led to an increase in the detection of patients allergic to AX who tolerate benzylpenicillin (BP).28 These reactions are called selective reactions to AX. The major antigenic de terminant of AX is the amoxicilloyl amide, which results from the opening of the βlactam ring by amino groups. 29 Although the structure of the possible antigen ic elements of cephalosporins is not well known, different experimental studies have proved that they can generate structures able to provoke spe cific immune response. 30 IgE antibodies that re act with cephalosporins have been shown to de tect a wide range of specificities, although the f...

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Section: Immediate or Immunoglobulin-e-mediated Reac-supporting

confidence: 59%

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Moreno¹,

Laffond²,

Muñoz-Bellido³

et al. 2017

Polish Archives of Internal Medicine

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“…Activation of basophils in these patients' blood can be measured by flow cytometry targeting the specific basophil markers CD63 or CD203c. Despite specificity of 93.3%, the sensitivity of BAT is only 50% although may be higher for cephalosporins [136,172,173]. In a cohort of 41 amoxicillin-allergic patients, followed up over a 4-year period with both BAT and RAST tests every 6 months, the disappearance of IgE-specific antibody was earlier with BAT than with RAST.…”

Section: Basophil Activation Testmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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“…For BAT, an optimal threshold>1.97 yields 51.4% sensitivity and 90.3% specificity. A SI>2 as optimal threshold for BAT positivity for antibiotics has been previously described in large multicenter studies, with 50% sensitivity (1,20,21). By comparing the ROC curves performed for R and SI, the area under curve and the sensitivity seems to be lower for BAT when compared to RIA, but the statistical significant difference has not been attained (p=0.11).…”

Section: Figure 2 Box-plot For Si Values (Stimulation Index) For Basmentioning

confidence: 71%

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

Petrișor¹,

Gherman-Ionica²,

Bologa³

et al. 2013

Romanian Review of Laboratory Medicine

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Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate‐type reactions to betalactam antibiotics

Abstract: The basophil activation test is a particularly useful technique in the diagnosis of patients with IgE-mediated allergy to betalactams and allows the identification of 50% of patients. Used in conjunction with CAP, it allows the identification of 65.5% of such patients.

Cited by 234 publications

References 18 publications

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Management of allergy to penicillins and other beta‐lactams

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

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