title: In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow.
abstract: BACKGROUND
  Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs.
  
  
  METHODS
  A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise.
  
  
  RESULTS
  BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs.
  
  
  CONCLUSIONS
  The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
authors.affiliation: Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Evelyne A
authors.initials: EA
authors.lastname: Mangodt
authors.forename: Athina L
authors.initials: AL
authors.lastname: Van Gasse
authors.forename: Ine
authors.initials: I
authors.lastname: Decuyper
authors.forename: Astrid
authors.initials: A
authors.lastname: Uyttebroek
authors.forename: Margaretha A
authors.initials: MA
authors.lastname: Faber
authors.forename: Vito
authors.initials: V
authors.lastname: Sabato
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bridts
authors.forename: Margo M
authors.initials: MM
authors.lastname: Hagendorens
authors.forename: Didier G
authors.initials: DG
authors.lastname: Ebo
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000276:immunology; D001491:Basophils / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000276:immunology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal