Comparing Basophil Activation Test and Specific IgE Assay in the Diagnosis of Allergy to Penicillin G and Ibuprofen
-
Parastoo Shakerin
,
Raheleh Shokouhi Shoormasti
,
Mohammad Reza Fazlollahi
,
Mahsa Jafari
,
Mona Delkhah
,
Parichehr Bahraini
,
Leila Moradi
,
Maryam Mahlooji Rad
,
Masoud Movahedi
,
Homa Sadri
,
Morteza Fallahpour
,
Alireza Shafiei
,
Fariborz Zandieh
,
Marzieh Tavakol
,
Mohammad Tajdini
,
Zahra Pourpak
Abstract
The risks associated with in vivo tests in the diagnosis of immediate drug hypersensitivities result in evaluating alternative in vitro tests, such as the Basophil Activation Test (BAT). This pilot study aimed to set up a BAT and compare it with a specific Immunoglobulin E (sIgE) assay for penicillin G and Ibuprofen in patients with immediate hypersensitivity to β-lactams or nonsteroidal anti-inflammatory drugs (NSAIDs).
Eleven subjects with a clear history of immediate hypersensitivity to one of the β-lactams (n=5), the NSAIDs (n=3), or both (n=3) entered this study. BAT and sIgE assays were performed regarding the patient’s history.
The most frequent manifestations were angioedema, shortness of breath, urticaria, and nausea. Eight patients had anaphylactic reactions. The results presented a positive BAT for penicillin G and one for Ibuprofen. Moreover, three patients with a history of the β-lactams reaction demonstrated positive sIgE to β-lactams in the ImmunoCAP. Despite a lack of agreement between the positive results of the BAT and sIgE assay, five patients were identified by one of these methods.
Despite positive BAT and sIgE results in two and three patients, respectively, the risks, high cost, and time-consuming nature of drug challenges render these tests valuable for reducing the number of patients who are candidates for a drug challenge.
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13. Kim MS, Cho YJ. Flow Cytometry-Assisted Basophil Activation Test as a Safe Diagnostic Tool for Aspirin/NSAID Hypersenstivity. Allergy Asthma Immunol Res. 2012;4(3):137-42.
14. Kim SY, Kim JH, Jang YS, Choi JH, Park S, Hwang YI, et al. The Basophil Activation Test Is Safe and Useful for Confirming Drug-Induced Anaphylaxis. Allergy Asthma Immunol Res. 2016;8(6):541-4.
15. Eberlein B, León Suárez I, Darsow U, Ruëff F, Behrendt H, Ring J. A new basophil activation test using CD63 and CCR3 in allergy to antibiotics. Clin Exp Allergy. 2010;40(3):411-8.
16. Mayorga C, Doña I, Perez-Inestrosa E, Fernández TD, Torres MJ. The Value of In Vitro Tests to DiminishDrug Challenges. Int J Mol Sci. 2017;18(6).
17. Reitmajer M, Strauss A, Klinger C, Maaß M, Kempf WE, Fischer J, et al. Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics. Front Allergy. 2024;Volume 5 - 2024.
18. Salas M, Fernández-Santamaría R, Mayorga C, Barrionuevo E, Ariza A, Posadas T, et al. Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy. J Allergy Clin Immunol Pract. 2018;6(3):1010-8.e2.
19. Campos L, Galvão VR, Kalil J, Castells M, Giavina-Bianchi P. BAT in the Diagnosis of Drug Allergy: a Novel Tool in Clinical Daily Practice? Curr Allergy Asthma Rep. 2019;19(4):20.
20. Au EY, Chiang V, Kan AKC, Lam K, Wong JC, Yeung HH, et al. A case of persistent IgE sensitisation almost two decades following ampicillin anaphylaxis. Allergol Immunopathol (Madr). 2023;51(2):126-9.
21. Arsène MMJ, Davares AKL, Viktorovna PI, Andreevna SL, Sarra S, Khelifi I, et al. The public health issue of antibiotic residues in food and feed: Causes, consequences, and potential solutions. Vet World. 2022;15(3):662-71.
22. Jammoul A, El Darra N. Evaluation of Antibiotics Residues in Chicken Meat Samples in Lebanon. Antibiotics (Basel, Switzerland). 2019;8(2).
23. Kvedariene V, Kamey S, Ryckwaert Y, Rongier M, Bousquet J, Demoly P, et al. Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils. Allergy. 2006;61(3):311-5.
24. Doña I, Torres MJ, Montañez MI, Fernández TD. In Vitro Diagnostic Testing for Antibiotic Allergy. Allergy Asthma Immunol Res. 2017;9(4):288-98.
25. Fernández TD, Torres MJ, Blanca-López N, Rodríguez-Bada JL, Gomez E, Canto G, et al. Negativization rates of IgE radioimmunoassay and basophil activation test in immediate reactions to penicillins. Allergy. 2009;64(2):242-8.
2. Macy E, Adkinson NF, Jr. The Evolution of Our Understanding of Penicillin Allergy: 1942-2022. J Allergy Clin Immunol Pract. 2023;11(2):405-13.
3. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188-99.
4. Kanannejad Z, Pourvali A, Esmaeilzadeh H, Shokouhi Shoormasti R, Reza Fazlollahi M, Fallahpour M, et al. Diagnosis and selection of alternative antibiotics in beta-lactams hypersensitivity reactions: Current recommendations and challenges. Int Immunopharmacol. 2023;122:110573.
5. Blanca-Lopez N, Soriano V, Garcia-Martin E, Canto G, Blanca M. NSAID-induced reactions: classification, prevalence, impact, and management strategies. J Asthma Allergy. 2019;12:217-33.
6. Makowska JS, Burney P, Jarvis D, Keil T, Tomassen P, Bislimovska J, et al. Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA2LEN) survey. Allergy. 2016;71(11):1603-11.
7. de Martino M, Chiarugi A, Boner A, Montini G, De' Angelis GL. Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal. Drugs. 2017;77(12):1295-311.
8. Doña I, Pérez-Sánchez N, Eguiluz-Gracia I, Muñoz-Cano R, Bartra J, Torres MJ, et al. Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Allergy. 2020;75(3):561-75.
9. Sipahi Cimen S, Yucel E, Suleyman A, Hizli Demirkale Z, Ozceker D, Sayili U, et al. Hypersensitivity to Ibuprofen: Real-Life Experience in Children with History of Suspected Immediate Reactions. Int Arch Allergy Immunol. 2023;184(1):33-42.
10. Santos AF, Alpan O, Hoffmann HJ. Basophil activation test: Mechanisms and considerations for use in clinical trials and clinical practice. Allergy. 2021;76(8):2420-32.
11. Leecyous B, Bakhtiar F, Tang MM, Yadzir ZHM, Abdullah N. Minimal agreement between basophil activation test and immunoassay in diagnosis of penicillin allergy. Allergol Immunopathol (Madr). 2020;48(6):626-32.
12. Marraccini P, Pignatti P, D'Alcamo A, Salimbeni R, Consonni D. Basophil activation test application in drug hypersensitivity diagnosis: an empirical approach. Int Arch Allergy Immunol. 2018;177(2):160-6.
13. Kim MS, Cho YJ. Flow Cytometry-Assisted Basophil Activation Test as a Safe Diagnostic Tool for Aspirin/NSAID Hypersenstivity. Allergy Asthma Immunol Res. 2012;4(3):137-42.
14. Kim SY, Kim JH, Jang YS, Choi JH, Park S, Hwang YI, et al. The Basophil Activation Test Is Safe and Useful for Confirming Drug-Induced Anaphylaxis. Allergy Asthma Immunol Res. 2016;8(6):541-4.
15. Eberlein B, León Suárez I, Darsow U, Ruëff F, Behrendt H, Ring J. A new basophil activation test using CD63 and CCR3 in allergy to antibiotics. Clin Exp Allergy. 2010;40(3):411-8.
16. Mayorga C, Doña I, Perez-Inestrosa E, Fernández TD, Torres MJ. The Value of In Vitro Tests to DiminishDrug Challenges. Int J Mol Sci. 2017;18(6).
17. Reitmajer M, Strauss A, Klinger C, Maaß M, Kempf WE, Fischer J, et al. Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics. Front Allergy. 2024;Volume 5 - 2024.
18. Salas M, Fernández-Santamaría R, Mayorga C, Barrionuevo E, Ariza A, Posadas T, et al. Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy. J Allergy Clin Immunol Pract. 2018;6(3):1010-8.e2.
19. Campos L, Galvão VR, Kalil J, Castells M, Giavina-Bianchi P. BAT in the Diagnosis of Drug Allergy: a Novel Tool in Clinical Daily Practice? Curr Allergy Asthma Rep. 2019;19(4):20.
20. Au EY, Chiang V, Kan AKC, Lam K, Wong JC, Yeung HH, et al. A case of persistent IgE sensitisation almost two decades following ampicillin anaphylaxis. Allergol Immunopathol (Madr). 2023;51(2):126-9.
21. Arsène MMJ, Davares AKL, Viktorovna PI, Andreevna SL, Sarra S, Khelifi I, et al. The public health issue of antibiotic residues in food and feed: Causes, consequences, and potential solutions. Vet World. 2022;15(3):662-71.
22. Jammoul A, El Darra N. Evaluation of Antibiotics Residues in Chicken Meat Samples in Lebanon. Antibiotics (Basel, Switzerland). 2019;8(2).
23. Kvedariene V, Kamey S, Ryckwaert Y, Rongier M, Bousquet J, Demoly P, et al. Diagnosis of neuromuscular blocking agent hypersensitivity reactions using cytofluorimetric analysis of basophils. Allergy. 2006;61(3):311-5.
24. Doña I, Torres MJ, Montañez MI, Fernández TD. In Vitro Diagnostic Testing for Antibiotic Allergy. Allergy Asthma Immunol Res. 2017;9(4):288-98.
25. Fernández TD, Torres MJ, Blanca-López N, Rodríguez-Bada JL, Gomez E, Canto G, et al. Negativization rates of IgE radioimmunoassay and basophil activation test in immediate reactions to penicillins. Allergy. 2009;64(2):242-8.
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| Keywords | ||
| Basophil activation test β-lactam Drug hypersensitivity Nonsteroidal anti-inflammatory drugs Specific IgE | ||
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How to Cite
1.
Shakerin P, Shokouhi Shoormasti R, Fazlollahi MR, Jafari M, Delkhah M, Bahraini P, Moradi L, Mahlooji Rad M, Movahedi M, Sadri H, Fallahpour M, Shafiei A, Zandieh F, Tavakol M, Tajdini M, Pourpak Z. Comparing Basophil Activation Test and Specific IgE Assay in the Diagnosis of Allergy to Penicillin G and Ibuprofen. Iran J Allergy Asthma Immunol. 2025;:1-8.
