Abstract
Lack of understanding of the antigenic determinants generated by cephalosporins have hindered the development of sensitive in vitro tests for the detection of cephalosporin mediated immediate hypersensitivity reactions (IHRs) and the in vivo tests are risky. Hence, the aim of this study was to investigate the utility of the basophil activation test (BAT) to diagnose cephalosporin mediated IHR. 16 patients with at least one manifestation consistent with IHRs to cephalosporins (recent history, intra-dermal skin testing (ST) and/or DPT) and 10 non-allergic negative controls were included. The BAT was conducted using a spectrum of beta-lactams including the culprit cephalosporin. Basophils were gated using CD45+/CD123+/HLA-DR-/±CD193+ and the CD63 up-regulation (>10% as compared with the baseline) was used as the activation marker. Cross reactivity were tested using 3–8 different beta-lactams in 15 patients. The sensitivity and specificity of the BAT was compared to the findings from the clinical diagnosis. A total of 26 individuals were recruited, including 16 with at least 1 manifestation consistent with a cephalosporin mediated IHR and 10 non-allergic controls. 270 and 220 BAT were performed with various beta-lactams in the patient and non-patient group. 6/16 subjects were deemed clinically allergic and BAT was positive in four of them, resulting in a sensitivity of the BAT of 66.6% and specificity of 100%. There was minimal cross-reactivity demonstrated between different Cephalosporins and BAT was concordant with the DPT outcomes in all of the subjects where results were comparable. Similar profile was seen in subjects tested for penicillins. BAT is a useful adjunct in testing patients with Cephalosporin allergies. It can help choose a safe alternative drug and avoid the need for performing multiple drug provocation tests to rule out cross-reactivity.
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