Basophil activation test in the food allergy clinic: its current use and future applications

Figures & data

Table 1. Proposed applications of the basophil activation test in clinical practice.

Diagnosis of food allergy in patients with equivocal skin test and specific IgE results prior to oral food challenge

Confirmation of allergic status to peanut, tree nuts and seeds in polysensitized children

Identification of tolerance to baked milk/egg in children with cow’s milk/egg allergies

Confirmation of eligibility for immunomodulatory treatments for food allergy

Monitoring for spontaneous resolution of food allergy

Prediction of success of immunomodulatory treatments for food allergy

Monitoring of clinical response to immunomodulatory treatments for food allergy

Figure 1. Proposed integration of the basophil activation test in the clinical pathway of patients with suspected food allergy – the stages of this process that include the basophil activation test are marked in orange.

Figure 2. Proposed diagnostic procedure in patients with suspected food allergy.

BAT, basophil activation test; PPV, positive predictive value; OFC, oral food challenge; sIgE, specific IgE.

Table 2. Diagnostic performance of the basophil activation test in different food allergies.

Food allergy	Stimulant used in BAT	Sensitivity	Specificity	Optimal cutoffs
Peanut	Peanut extract [2]* Ara h 2 [14] Ara h 2 [15]	84% 92% 79.2%	90% 77% 94.3	5% CD63+ ND ND
Sesame	Sesame extract [2]*	89%	93%	10.9% CD63+
Hazelnut	Hazelnut extract [16] Hazelnut extract [15]	100% 80.8%	97% 87.7%	CD-sens >1.7 ND
Almond	Almond extract [15]	100%	80%	ND
Cashew	Cashew extract [15]	82.9%	87.5%	ND
Egg	Ovalbumin [11] Egg white extract [13]	77% 62%	100% 92%	5% for CD63+ 32.5% for CD63
Baked egg	Egg white extract [17] Ovomucoid [17]	74% 80%	62% 73%	SI CD203c > 2.4 SI CD203c > 1.7
Cow’s milk	Cow’s milk extract [18] Cow’s milk extract [17] Casein [17]	91% 89%	90% 83%	>6% CD63+ SI CD203c > 1.9
Wheat	Wheat extract [19] Omega 5-gliadine (nTri a19) [19] Omega 5-gliadine (nTri a19) [19]	86% 86% 83%	58% 58% 63%	>11.1% CD202c+ >11.1% CD202c+ >7.9% CD202c+

BAT, basophil activation test; ND, non-defined; SI, stimulation index *Systematic review and metanalysis.

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