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Basophil activation testing in diagnosis and monitoring of allergic disease – an overview

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Abstract

The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. Through the development of flow cytometry, discovery of activation markers such as CD63 and markers identifying basophil granulocytes, the basophil activation test (BAT) has become a pervasive test. BAT measures basophil response to allergen crosslinking IgE on between 150 and 2,000 basophil granulocytes with remarkable analytical sensitivity in < 0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils. In patients with food-, insect venom-, and drug allergy and patients with chronic urticaria BAT can be part of the diagnostic evaluation in addition to history, skin prick testing, and specific IgE determination. BAT may also be helpful in determining the clinically relevant allergen. Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment, or in the natural resolution of allergy. The test may use fewer resources and be more reproducible than oral, sting, nasal or bronchial challenge testing. BAT may be useful before challenge testing as it is less stressful for the patient and avoids severe allergic reactions. It may be useful before challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories. This article provides an overview of the practical and technical details as well as the utility of BAT in diagnosis and management of allergic diseases.

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Abbreviations

AIT:

Allergen-specific immunotherapy ASST Autologous serum skin test

BAT:

Basophil activation test

CU:

Chronic spontaneous urticaria

DHR:

Drug hypersensitivity reactions

FcεRI:

High affinity IgE-receptor

IL-3:

Interleukin-3

NMBA:

Neuromuscular blocking agent

sIgE:

Specific IgE

SPT:

Skin prick test

VIT:

Venom immunotherapy

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Author information

Authors and Affiliations

  1. Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany

    Bernadette Eberlein

  2. Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King’s College London, London, UK

    Alexandra F. Santos

  3. MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK

    Alexandra F. Santos

  4. Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal

    Alexandra F. Santos

  5. Research Laboratory and Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain

    Cristobalina Mayorga

  6. Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

    Anna Nopp

  7. Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain

    Marta Ferrer & Maria L. Sanz

  8. Department of Immunology, University Hospital, Clermont-Ferrand and ERTICa Research Group, University of Auvergne EA4677, Clermont-Ferrand, France

    Paul Rouzaire

  9. Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium

    Didier Ebo & Vito Sabato

  10. Adverse Drug Reactions-Analysis and Consulting (ADR-AC) GmbH, Bern, Switzerland

    Tatjana Pecaric-Petkovic

  11. Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Sarita U. Patil & Wayne G. Shreffler

  12. Department of Rheumatology, Immunology and Allergology, Inselspital, University of Bern, Bern, Switzerland

    Oliver V. Hausmann

  13. Loewenpraxis, Luzern, Switzerland

    Oliver V. Hausmann

  14. Laboratory for Clinical Immunology & Molecular Genetics, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia

    Peter Korosec

  15. Department of Immunology and Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands

    Edward F. Knol

  16. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Hans Jürgen Hoffmann

  17. Department of Respiratory Diseases and Allergy, Aarhus University, Aarhus, Denmark

    Hans Jürgen Hoffmann

  18. Klinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Straße 29, 80802, München, Germany

    Bernadette Eberlein

Authors
  1. Bernadette Eberlein
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  2. Alexandra F. Santos
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  3. Cristobalina Mayorga
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  4. Anna Nopp
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  5. Marta Ferrer
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  6. Paul Rouzaire
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  7. Didier Ebo
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  8. Vito Sabato
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  9. Maria L. Sanz
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  10. Tatjana Pecaric-Petkovic
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  11. Sarita U. Patil
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  12. Oliver V. Hausmann
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  13. Wayne G. Shreffler
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  14. Peter Korosec
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  15. Edward F. Knol
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  16. Hans Jürgen Hoffmann
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Corresponding author

Correspondence to Bernadette Eberlein.

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Interessenkonflikt

Eberlein B, Santos AF, Patil SU, Shreffler WG, and Hausmann OV obtained research funding and Eberlein B and Hausmann OV received speaker honoraria from Bühlmann Laboratories, Schoenenbuch, Switzerland. Eberlein B received research funding from BD Biosciences, Erembodegem, Belgium. Nopp A received research funding from Novartis, Basel, Switzerland. Hoffmann HJ, Mayorga C, Ferrer M, Rouzaire P, Ebo D, Sabato V, Sanz ML, Pecaric-Petkovic T, Korosec P, and Knol EF confirm that there are no conflicts of interest.

Zitierweise

Eberlein B, Santos AF, Mayorga C, Nopp A, Ferrer M, Rouzaire P, Ebo D, Sabato V, Sanz ML, Pecaric-Petkovic T, Patil SU, Hausmann OV, Shreffler WG, Korosec P, Knol EF, Hoffmann HJ. Basophil activation testing in diagnosis and monitoring of allergic disease —s an overview. Allergo J Int 2016;25:106–13 DOI: 10.1007/s40629-016-0113-5

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Eberlein, B., Santos, A.F., Mayorga, C. et al. Basophil activation testing in diagnosis and monitoring of allergic disease – an overview. Allergo J 25, 26–33 (2016). https://doi.org/10.1007/s15007-016-1105-y

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