title: The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams.
abstract: BACKGROUND
  Basophil activation by allergens, including drugs, has been used to determine sensitivity and to study IgE recognition and cross-reactivity.
  
  
  OBJECTIVE
  We sought to determine the sensitivity and specificity of a basophil activation test (Basotest) in patients with immediate allergic reactions to betalactams, with a later comparison between patients who were selective (those recognizing the culprit drug excluding benzylpenicillin (BP)) and cross-reactors (those recognizing several penicillin determinants including BP).
  
  
  METHODS
  Basotest to different haptens was performed in 70 patients with immediate allergic reactions to betalactams, classified into three groups: (A) skin test positive independently of CAP/RAST immunoassay value, (B) skin test negative and CAP/RAST positive, and (C) skin test and CAP/RAST negative but drug provocation test positive. Basotest was carried out by flow cytometry following the manufacturer's instructions using different betalactam determinants and results expressed as a stimulation index.
  
  
  RESULTS
  Of the 70 patients, 34 (48.6%) were positive to Basotest (sensitivity: 48.6%), 31 (44.3%) to CAP/RAST and 46 (65.7%) to either one or the other. Considering the different groups, Basotest was positive in 50.9% of patients in Group A, 60% in Group B and 14.3% in Group C. The specificity was 91.3%. Positivity to the haptens was 28.6% to amoxicillin (AX), 21.7% to BP, 20% to benzylpenicilloyl-poly-l-lysine, 12.5% to ampicillin and 2.2% to minor determinant mixture. In patients with cephalosporin reactions, Basotest to the culprit cephalosporin was positive in 77.7%. There were differences between the two reactor groups in the sensitivity of Basotest (selective to AX=50%, cross-reactors=28.6%; chi(2)=10.809, P=0.004) and in the CAP/RAST (selective to AX=28.6%, cross-reactors=61.9%; chi(2)=8.944, P=0.011).
  
  
  CONCLUSIONS
  The sensitivity of Basotest is similar to immunoassays (CAP/RAST). Sensitivity is improved when used in combination. Although further studies are required, Basotest results for cephalosporin allergy seem very promising. This technique does not help differentiate between selective reactors and cross-reactors.
authors.affiliation: Research Unit for Allergic Diseases, Allergy Service, Carlos Haya Hospital, Málaga, Spain. mariaj.torres.sspa@juntadeandalucia.es
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.forename: A
authors.initials: A
authors.lastname: Padial
authors.forename: C
authors.initials: C
authors.lastname: Mayorga
authors.forename: T
authors.initials: T
authors.lastname: Fernández
authors.forename: E
authors.initials: E
authors.lastname: Sanchez-Sabate
authors.forename: J A
authors.initials: JA
authors.lastname: Cornejo-García
authors.forename: C
authors.initials: C
authors.lastname: Antúnez
authors.forename: M
authors.initials: M
authors.lastname: Blanca
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015549:Basophil Degranulation Test / Q000379:methods*; D001491:Basophils / Q000276:immunology; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D012882:Skin Tests / Q000379:methods; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D007073:Immunoglobulin E