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Abstract
Challenges in in vitro allergy diagnostics lie in the development of accessible and reliable assays allowing identification of all offending allergens and cross-reactive structures. Flow-assisted analysis and quantification of in vitro activated basophils serves as a diagnostic instrument with increasing applications developed over the years. From the earliest days it was clear that the test could constitute a diagnostic asset in basophil-mediated hypersensitivity. However, utility of the basophil activation test should be reassessed regarding difficulties with preparation, characterization and validation of allergen extracts; availability and the potential of more accessible diagnostics. Today, the added value mainly lies in diagnosis of immediate drug hypersensitivity. Other potential indications are monitoring venom-immunotherapy and follow-up of natural history of food allergies. However, results in these nondiagnostic applications are preliminary. We review the most relevant clinical applications of the basophil activation test. Some personal comments and views about perspectives and challenges about flow-assisted allergy diagnosis are made.
Financial & competing interests disclosure
DG Ebo is a Senior Clinical Researcher of the Research Foundation Flanders (FWO: 1800614N). V Sabato is a Clinical Researcher of the Research Foundation Flanders (FWO: 1700614N). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
In vitro activation of basophils (basophil activation test, BAT) constitutes a useful and safe diagnostic test that can be applied for IgE-dependent and probably also for IgE-independent basophil- and mast cell-mediated hypersensitivity reactions.
Nowadays, application of BAT in food and hymenoptera venom allergy needs to be reconsidered in view of the new, more accessible diagnostic tools, for example, component resolved diagnosis.
Today the usefulness of BAT has mainly to be sought in the domain of drug hypersensitivity diagnosis.
Sufficient numbers of well-identified patients and (exposed) control individuals are needed to study and validate BAT in drug allergy.
Studies regarding BAT in drug allergy should adopt standardized (clinical and laboratory) protocols on which inclusion of individuals can be based.
BAT with simultaneous analyses of intracellular signaling and histamine release might not only improve diagnosis of drug hypersensitivity but also help elucidate drug-mediated basophil and mast cell activation pathways.
Other applications of BAT involve monitoring of allergen-specific immunotherapy and occurrence of natural tolerance.