Basophil Activation as Marker of Clinically Relevant Allergy and Therapy Outcome

Abstract

For some years now the basophil activation test (BAT) using flow cytometry has emerged as a powerful tool and sensitive marker that can be used to detect clinically relevant allergies, provide information on the severity of an allergic reaction, and monitor therapies. Compared to other in vitro diagnostic tests, BAT seems to have a better informative value in terms of clinical relevance. In general, the BAT can be used for the diagnosis of the most common forms of IgE-mediated allergy such as hymenoptera venom allergy, inhalant allergy, food allergy, and drug allergy. Various basophil markers and parameters have been established which, depending on the trigger of the respective allergy, can provide information on the clinical relevance of sensitization, on the development of natural tolerance, on trigger thresholds, and on the severity of the allergic reaction. The BAT also serves as a suitable follow-up instrument for various therapeutic approaches such as specific immunotherapy, desensitization protocols, or use of anti-IgE-antibodies for the various diseases. Quality controls for routine use, standardization, and automatization are expected to expand the range of applications for the above-mentioned indications.

Characterization of New Allergens from the Venom of the European Paper Wasp Polistes dominula

“…Its main advantage over the classical approach of measuring sIgE against an allergen in experimental studies is the built-in downstream readout (the upregulation of CD63 on basophilic cells) that allows conclusions about an allergens’ ability to cross-link FcεRI on effector cells. BATs are frequently used in the context of venom allergies and have greatly improved diagnostics [ 40 , 41 ]. However, PLA2 did not lead to activation of basophilic cells in any of the 30 patients tested.…”

Basophil activation test in the diagnostics of hymenoptera venom allergy

“…The BAT is essentially an assay with superior specifi city compared to any other allergy testing. If appropriately used, it can provide a valuable clinical asset in different areas of allergy diagnostics (23,24,25). Measurement and comparison of basophil sensitivity during the allergen immunotherapy can improve treatment response monitoring (10,15).…”

“…A controlled sting challenge is considered to be the gold standard to evaluate the clinical response of the patient, allowing a reliable conclusion about the success of VIT (26). Despite maximum safety precautions and standby of emergency management, there is a potential of severe anaphylaxis, therefore sting challenge with a live insect is not perform routinely (25).…”

The Emerging Role of the Innate Immune Response in Idiosyncratic Drug Reactions

“…Indeed, the basophil activation test is used as a reliable diagnostic tool for identifying various allergens. In the context of drug allergy, however, the basophil activation test is not as sensitive as it is in identifying other types of allergens (Eberlein, 2020). Possibly, this could be because the covalent modification of proteins by drugs produces a range of antigens such that it is not accurately reproduced in vitro.…”