Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics
BackgroundAllergy to beta-lactam antibiotics (BLA), especially to penicillin, is the most commonly reported drug allergy by patients. Alternative antibiotics can yield negative consequences, such as extended hospitalization days due to less efficacy and overall higher costs. The basophil activation...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Allergy |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/falgy.2024.1512875/full |
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| author | Markus Reitmajer Antonia Strauss Christian Klinger Maximiliane Maaß Wolfgang E. Kempf Wolfgang E. Kempf Joerg Fischer Joerg Fischer Manfred Kneilling Manfred Kneilling Sebastian Volc Sebastian Volc |
| author_facet | Markus Reitmajer Antonia Strauss Christian Klinger Maximiliane Maaß Wolfgang E. Kempf Wolfgang E. Kempf Joerg Fischer Joerg Fischer Manfred Kneilling Manfred Kneilling Sebastian Volc Sebastian Volc |
| author_sort | Markus Reitmajer |
| collection | DOAJ |
| description | BackgroundAllergy to beta-lactam antibiotics (BLA), especially to penicillin, is the most commonly reported drug allergy by patients. Alternative antibiotics can yield negative consequences, such as extended hospitalization days due to less efficacy and overall higher costs. The basophil activation test (BAT) is an in vitro assay, in which activation of an individual's own basophils is quantified by flow cytometry. It is an increasingly applied in vitro method in allergy testing that is also gaining traction in drug allergies.MethodsWe correlated 37 BAT results with skin test results. The cohort exclusively included patients with suspected type I BLA allergy. In addition, we examined the concordance of these results with clinical symptoms reported in the BLA patients’ medical histories.ResultsBLA-BAT revealed a high specificity of 92.3% [95% confidence interval (CI) 66.7–98.6] but a low sensitivity of only 20.8% (95% CI 9.24–40.47) using BLA-skin tests as a comparator. Negative BLA-BAT in patients with a history of grade I anaphylaxis yielded doubt on the assumption of grading. The exclusion of grade I BLA anaphylaxis increased the sensitivity to 29.4% (95% CI 13.28–53.13) with a still high specificity of 85.7% (95% CI 48.69–97.43). When ImmunoCAP was available, we compared specific IgE and BAT results by using Cohens' kappa (κ) and revealed a moderate level of agreement (κ = 0.538, p = 0.029).ConclusionBAT reveals specific positive results exclusively in patients with cephalosporin anaphylaxis. However, these findings could not be generally confirmed in the heterogeneous group of BLA. |
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| institution | OA Journals |
| issn | 2673-6101 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Allergy |
| spelling | doaj-art-0f4ce107c13e4acaa102fcde0363a4702025-08-20T02:31:56ZengFrontiers Media S.A.Frontiers in Allergy2673-61012024-12-01510.3389/falgy.2024.15128751512875Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibioticsMarkus Reitmajer0Antonia Strauss1Christian Klinger2Maximiliane Maaß3Wolfgang E. Kempf4Wolfgang E. Kempf5Joerg Fischer6Joerg Fischer7Manfred Kneilling8Manfred Kneilling9Sebastian Volc10Sebastian Volc11Department of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyFACS Core Facility Location Tal, Department of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology and Allergology, University Augsburg, Augsburg, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyDepartment of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University, Tuebingen, GermanyDepartment of Dermatology, Eberhard Karls University, Tuebingen, GermanyFACS Core Facility Location Tal, Department of Dermatology, Eberhard Karls University, Tuebingen, GermanyBackgroundAllergy to beta-lactam antibiotics (BLA), especially to penicillin, is the most commonly reported drug allergy by patients. Alternative antibiotics can yield negative consequences, such as extended hospitalization days due to less efficacy and overall higher costs. The basophil activation test (BAT) is an in vitro assay, in which activation of an individual's own basophils is quantified by flow cytometry. It is an increasingly applied in vitro method in allergy testing that is also gaining traction in drug allergies.MethodsWe correlated 37 BAT results with skin test results. The cohort exclusively included patients with suspected type I BLA allergy. In addition, we examined the concordance of these results with clinical symptoms reported in the BLA patients’ medical histories.ResultsBLA-BAT revealed a high specificity of 92.3% [95% confidence interval (CI) 66.7–98.6] but a low sensitivity of only 20.8% (95% CI 9.24–40.47) using BLA-skin tests as a comparator. Negative BLA-BAT in patients with a history of grade I anaphylaxis yielded doubt on the assumption of grading. The exclusion of grade I BLA anaphylaxis increased the sensitivity to 29.4% (95% CI 13.28–53.13) with a still high specificity of 85.7% (95% CI 48.69–97.43). When ImmunoCAP was available, we compared specific IgE and BAT results by using Cohens' kappa (κ) and revealed a moderate level of agreement (κ = 0.538, p = 0.029).ConclusionBAT reveals specific positive results exclusively in patients with cephalosporin anaphylaxis. However, these findings could not be generally confirmed in the heterogeneous group of BLA.https://www.frontiersin.org/articles/10.3389/falgy.2024.1512875/fullbeta-lactam-antibioticbasophil activation testtype 1 allergyhypersensitivitydelabeling |
| spellingShingle | Markus Reitmajer Antonia Strauss Christian Klinger Maximiliane Maaß Wolfgang E. Kempf Wolfgang E. Kempf Joerg Fischer Joerg Fischer Manfred Kneilling Manfred Kneilling Sebastian Volc Sebastian Volc Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics Frontiers in Allergy beta-lactam-antibiotic basophil activation test type 1 allergy hypersensitivity delabeling |
| title | Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics |
| title_full | Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics |
| title_fullStr | Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics |
| title_full_unstemmed | Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics |
| title_short | Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics |
| title_sort | determining the role of basophil activation testing in reported type 1 allergy to beta lactam antibiotics |
| topic | beta-lactam-antibiotic basophil activation test type 1 allergy hypersensitivity delabeling |
| url | https://www.frontiersin.org/articles/10.3389/falgy.2024.1512875/full |
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