Diagnosis of immediate-type ß-lactam allergy in vitro by flow-cytometric basophil activation test and sulfidoleukotriene production: A multicenter study

A. L. De Week, M. L. Sanz, P. M. Gamboa, W. Aberer, G. Sturm, M. B. Bilo, M. Montroni, M. Blanca, M. J. Torres, L. Mayorga, P. Campi, M. Manfredi, M. Drouet, J. Sainte-Laudy, A. Romano, H. Merk, J. M. Weber, T. M. Jermann

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: This multicenter study aimed to evaluate the diagnostic value of 2 cellular tests based on basophil reactivity-the basophil activation test (BAT, Flow-CAST) and the sulfidoleukotriene release assay (CAST-ELISA)-in immediate-type 6-lactam allergy, particularly in patients with a clinical history of allergy and a negative skin test result. Material and Methods: In a multicenter study encompassing 10 European centers, 181 patients with a history of immediate-type ß-lactam allergy, and 81 controls, we evaluated the diagnostic efficiency of specific IgE determinations and of 2 cellular tests based on basophil reactivity, the BAT and the sulfidoleukotriene release assay. Results: With Flow-CAST, sensitivity varied for individual ß-lactam allergens from 16% for penicilloyl-polylysine to 33% for amoxicillin, reaching 50% when all 5 allergens were considered. In ß-lactam-allergic patients with negative skin test results (22.8%), Flow-CAST showed positive results for at least 1 of the 5 allergens in 37%. Specificity varied from 89% to 97%, depending on the allergens used. In CAST-ELISA, the overall sensitivity in skin test-positive patients was 41.7%; in patients with negative skin test results it was 27.9%. Both tests were not absolutely correlated, so that when all the results were considered together, sensitivity increased to 64.3% and specificity varied for both tests combined from 73% to 92%. In contrast, specific IgE determinations in the same population yielded a lower sensitivity (28.3%). Conclusions: A diagnostic algorithm including skin tests and specific IgE, followed by cellular tests in negative patients and controlled challenge enabled us to confirm ß-lactam allergy in 92% of cases. This procedure would also allow us to avoid two-thirds of the required controlled challenges.

Keywords

  • BAT
  • Cellular tests
  • Immediate-type ß-lactam allergy
  • In vitro diagnosis
  • Sulfidoleukotriene production

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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