Abstract
SummaryThe diagnosis of IgE‐mediated food allergy based solely on the clinical history and the documentation of specific IgE to whole allergen extract or single allergens is often ambiguous, requiring oral food challenges (OFCs), with the attendant risk and inconvenience to the patient, to confirm the diagnosis of food allergy. This is a considerable proportion of patients assessed in allergy clinics. The basophil activation test (BAT) has emerged as having superior specificity and comparable sensitivity to diagnose food allergy, when compared with skin prick test and specific IgE. BAT, therefore, may reduce the number of OFC required for accurate diagnosis, particularly positive OFC. BAT can also be used to monitor resolution of food allergy and the clinical response to immunomodulatory treatments. Given the practicalities involved in the performance of BAT, we propose that it can be applied for selected cases where the history, skin prick test and/or specific IgE are not definitive for the diagnosis of food allergy. In the cases that the BAT is positive, food allergy is sufficiently confirmed without OFC; in the cases that BAT is negative or the patient has non‐responder basophils, OFC may still be indicated. However, broad clinical application of BAT demands further standardization of the laboratory procedure and of the flow cytometry data analyses, as well as clinical validation of BAT as a diagnostic test for multiple target allergens and confirmation of its feasibility and cost‐effectiveness in multiple settings.
Highlights
The prevalence of IgE-mediated food allergy is increasing and so is the public awareness about food allergy, which together have resulted in a high demand for food allergy testing.[1,2] Following the clinical assessment of patients, which includes the clinical history and a detailed dietary history, diagnosing IgE-mediated food allergy requires documentation of food-specific IgE using skin prick testing (SPT) and/or specific IgE testing.[3]
Given the practicalities involved in the performance of basophil activation test (BAT), we propose that it can be applied for selected cases where the history, skin prick test and/or specific IgE are not definitive for the diagnosis of food allergy
In the cases that the BAT is positive, food allergy is sufficiently confirmed without oral food challenges (OFCs); in the cases that BAT is negative or the patient has non-responder basophils, OFC may still be indicated
Summary
The prevalence of IgE-mediated food allergy is increasing and so is the public awareness about food allergy, which together have resulted in a high demand for food allergy testing.[1,2] Following the clinical assessment of patients, which includes the clinical history and a detailed dietary history, diagnosing IgE-mediated food allergy requires documentation of food-specific IgE using skin prick testing (SPT) and/or specific IgE testing.[3]. The proportion of activated basophils in response to allergen in vitro, socalled basophil reactivity, has been directly correlated with the severity of symptoms experienced during OFC in studies of mostly peanut and cow’s milk-allergic patients.[68,79,80] Measures of in vitro basophil sensitivity, such as “CD-sens,” in one study[79] and the ratio between activated basophils following stimulation with allergen and an IgE-mediated control in another study[68] have been correlated with the threshold of reactivity during OFC These data suggest that BAT can provide information about the severity and the threshold of allergic reactions that, in addition to other clinical characteristics of the patients that have been identified as risk factors (e.g., persistent asthma), might enable the clinician to identify high-risk allergic patients who require closer follow-up and more intensified education.
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