The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams

Torres, Marı́a José; Padial, A.; Mayorga, Cristobalina; Fernández, Tahía D.; Sánchez-Sabaté, Elena; Cornejo-García, José Antonio; Antúnez, C.; Blanca, Miguel

doi:10.1111/j.1365-2222.2004.02110.x

Cited by 173 publications

(161 citation statements)

References 21 publications

(47 reference statements)

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“…Our results, as well as those found by Torres et al (Torres et al, 2004), showed that the sensitivity of BAT in the diagnosis of immediate hypersensitivity reactions to beta-lactams was 50%, and the specificity 93.3%, although there were certain differences depending on the technique applied (e.g., use of total blood or isolated cells) (de Weck et al, 2008a).…”

Section: Basophil Activation Test and Sulphidoleukotriene Production supporting

confidence: 85%

“…Numerous studies over recent years have shown the usefulness of this technique for the in vitro diagnosis of allergic diseases (Ebo et al, 2006a(Ebo et al, , 2004aKleine-Tebbe et al, 2006) involving different allergens, such as inhalants (Paris-Köhler et al, 2000;Saporta et al, 2001), hymenoptera venoms (Sabbah et al, 1998;Sainte-Laudy et al, 2000), or latex (Ebo et al, 2002;Sanz et al, 2003). For the diagnosis of allergy to drugs like muscle relaxants (Abuaf et al, 1999;Monneret et al, 2002), betalactam antibiotics (Sanz et al, 2001b(Sanz et al, , 2002aTorres et al, 2004), pyrazolones (Sabbah et al, 1997;Sanz et al, 2005) and non steroidal anti-inflammatory drugs (NSAIDs) BAT has opened up an important diagnostic pathway, either on its own or combined with other techniques (de Weck et al, 2008b;Gamboa et al, 2003a), allowing avoidance of challenge tests in an important number of cases (Hausmann et al, 2009;Sanz et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Drug Hypersensitivity

Mara¹,

Mayorga²,

Martnez-Aranguren³

et al. 2012

Allergic Diseases - Highlights in the Clinic, Mechanisms and Treatment

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Section: Basophil Activation Test and Sulphidoleukotriene Production supporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Drug Hypersensitivity

Mara¹,

Mayorga²,

Martnez-Aranguren³

et al. 2012

Allergic Diseases - Highlights in the Clinic, Mechanisms and Treatment

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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

216

220

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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: 70%

“…A diagnostic approach using skin tests, IgE dosing and drug challenge is necessary in the diagnosis of β-lactam allergy since none has sufficient sensitivity to be used alone (25). BAT has a similar sensitivity to immunoassays, but the combination of both tests improves sensitivity (20). The performance of BAT in patients with negative skin tests and negative IgE results might avoid potentially dangerous challenge tests.…”

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

confidence: 99%