The Value of Current Laboratory Tests in Diagnosing Food, Venom, and Drug Allergies

Wang, Julie; Golden, David B.K.; Khan, David A.

doi:10.1016/j.jaip.2023.06.021

Cited by 7 publications

(3 citation statements)

References 77 publications

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“…Additionally, the pBHRA represents an alternative if BATs or BHRA cannot be performed due to the lack of fresh full blood. Taken together, in this study, we could confirm the previously reported [12,14,15,24] strengths and limitations of the three different in vitro tests; all of them are useful when no commercial allergen source for sIgE detection is available, and they represent good models for basophil reactivity. The BATs and aBHRA have the limitation of immediate sample processing and some patients having nonresponding basophils, but they show good results in weakly sensitized patients.…”

Section: Discussionsupporting

confidence: 88%

“…In contrast to other allergies like Hymenoptera venom allergy [12], the basophil activation test (BAT), based on the measurement of the basophil activation markers such as CD63 by flow cytometry, is not yet a routine diagnostic tool for WALDA. However, the BAT has been shown to discriminate patients and controls and to help identify the individual sensitization patterns to different wheat allergens in WALDA patients, especially when looking at allergens exceeding the established and commercially available extracts [8,11,13].…”

Section: Introductionmentioning

confidence: 99%

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Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA)

Faihs,

Schmalhofer,

Kugler

et al. 2024

IJMS

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Wheat allergy dependent on augmentation factors (WALDA) is the most common gluten allergy in adults. IgE-mediated sensitizations are directed towards ω5-gliadin but also to other wheat allergens. The value of the different in vitro cellular tests, namely the basophil activation test (BAT) and the active (aBHRA) and passive basophil histamine-release assays (pBHRA), in the detection of sensitization profiles beyond ω5-gliadin has not been compared. Therefore, 13 patients with challenge-confirmed, ω5-gliadin-positive WALDA and 11 healthy controls were enrolled. Specific IgE (sIgE), skin prick tests, BATs, aBHRA, and pBHRA were performed with allergen test solutions derived from wheat and other cereals, and results were analyzed and compared. This study reveals a distinct and highly individual reactivity of ω5-gliadin-positive WALDA patients to a range of wheat allergens beyond ω5-gliadin in cellular in vitro tests and SPT. In the BAT, for all tested allergens (gluten, high-molecular-weight glutenin subunits, α-amylase/trypsin inhibitors (ATIs), alcohol-free wheat beer, hydrolyzed wheat proteins (HWPs), rye gluten and secalins), basophil activation in patients was significantly higher than in controls (p = 0.004–p < 0.001). Similarly, significant histamine release was detected in the aBHRA for all test substances, exceeding the cut-off of 10 ng/mL in all tested allergens in 50% of patients. The dependency of tests on sIgE levels against ω5-gliadin differed; in the pBHRA, histamine release to any test substances could only be detected in patients with sIgE against ω5-gliadin ≥ 7.7 kU/L, whereas aBHRA also showed high reactivity in less sensitized patients. In most patients, reactivity to HWPs, ATIs, and rye allergens was observed. Additionally, alcohol-free wheat beer was first described as a promising test substance in ω5-gliadin-positive WALDA. Thus, BAT and aBHRA are valuable tools for the identification of sensitization profiles in WALDA.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA)

Faihs,

Schmalhofer,

Kugler

et al. 2024

IJMS

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“…Determining the sensitivity and specificity of BAT is a crucial step in clinical Allergen stimulation divided by negative control validation. Although demonstrating variations between foods, BAT has a high sensitivity and specificity for food allergies [27][28][29][30]. The sensitivity of BAT for drug allergies is lower, but it can still be very helpful before considering provocation tests in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of drugs for which there are no other tests available or their results are ambiguous [1].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Koumaki,

Gregoriou,

Evangelou

et al. 2023

Dermatol Ther (Heidelb)

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Introduction:The basophil activation test (BAT) is a flow cytometry laboratory technique that assesses the level of activation indicators expressed on the surface of basophils. We conducted a real-life study in a prospective cohort of patients with reported drug hypersensitivity reactions to determine the true relevance of BAT as a diagnostic tool for assessing immediate hypersensitivity reactions to medicines. Methods: We prospectively assessed individuals with clinical suspicion of immediate hypersensitivity reactions to drugs over a 2-year period.The allergological evaluation was carried out in accordance with European Academy of Allergy and Clinical Immunology (EAACI) guidance. All patients underwent BAT using the activation marker CD63. Results: In total 13 patients with 54 reported immediate drug hypersensitivity reactions to medications were included in this study. Twelve were female (92.3%) and one was male (7.70%). The mean ± SD age of the patients was 47.31 ± 19.94 years. Antibiotics were tested in 35.2% (19/54) of patients, corticosteroids in 24.1% (13/54), iodinated contrast medium in 14.8% (8/54), and NSAIDs in 5.6% (3/54). There was no correlation between the BAT results and the age of patients, gender, type of medication, or time interval between the allergic reaction and BAT procedure. The sensitivity of BAT 5% CD63 ? basophils to drugs was 97.6%, specificity was 96% for drug allergies, positive predictive value (PPV) was 94.3%, and negative predictive value (NPV) was 95.2%. Conclusions: The sensitivity of BAT for drug allergies is limited, but it can nevertheless be very helpful before contemplating provocation testing in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of medications for which no other tests are available or their results are ambiguous.

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Serologic measurements for peanut allergy

Conway,

Golden,

Brough

et al. 2024

Annals of Allergy, Asthma & Immunology

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The Value of Current Laboratory Tests in Diagnosing Food, Venom, and Drug Allergies

Cited by 7 publications

References 77 publications

Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA)

Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA)

Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions

Serologic measurements for peanut allergy

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