Abstract
The currently available in vitro and in vivo tests for the diagnosis of type 1 hypersensitivity reactions towards beta-lactams lacks sensitivity and specificity and challenges carry carry significant risks. The basophil activation test (BAT) represents a sensitive and safe alternative for the same. All patients with presumed immediate hypersensitivity reactions to betalactams referred for testing to Immunology unit at RAH underwent BAT and other routine tests as per our protocol. Basophils were gated using CD45+/CD123+/HLADR- gate and CD63 upregulation (>15% as compared to baseline) was used as an activation marker. The BAT results were compared with the specific IgE (sIgE) and skin test (ST) along with the evocative clinical history +/− drug provocation test (DPT). A total of 75 BAT with various beta-lactams were performed in 17 patients consisting of 6 cephalosporin and 11 penicillin allergic individuals. In the 6 cephalosporin allergic individual, 4 exhibited significant basophil activation and two gave negative response to the culprit drug. These were in concordance with the ST and history, thus yielding a 100%sensitivity and specificity. In case of the 11 penicillin allergic individuals, one result was uninterpretable due to baseline activation with the negative control. In 6 out of 10 individuals, BAT results were concordant with the other tests whereas three false negative and one false positive were obtained with amoxicillin and benzyl penicillin respectively. In this group 4/5 gave the same result with both BAT and DPT, apart from one for which a false negative BAT result was obtained. Cross reactivity analysis in both of the beta-lactam group by BAT were found to be highly sensitive. The BAT appears to be a sensitive assay to diagnose beta-lactam allergy and assess cross-reactivity. Further data needs to be generated for the validation of the test in a larger cohort.
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