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Updated: Aug 1, 2026
Basophil Activation Test for Investigation of IgE-Mediated Mechanisms in Drug Hypersensitivity
Published on: September 16, 2011
Cysteinyl-leukotriene release test (CAST) in the diagnosis of immediate drug reactions
B Lebel1, D Messaad, V Kvedariene
1Maladies Respiratoires, INSERM U454 - IFR3, CHU de Montpellier, Montpellier Cedex, France.
Background:
The diagnosis of allergic reactions to drugs is difficult. Most skin tests are not standardized, and in vitro tests are needed to avoid provocation tests. Cross-linking of IgE on basophils is known to cause the release of both cysteinyl leukotriene (Cys-LT) and histamine. We aimed to evaluate the diagnostic utility (sensitivity, specificity, and efficiency) of measurement of sulfidoleukotrienes in drug allergy.
Methods:
We performed a prospective study in 55 patients with proven immediate adverse reactions to drugs (30 to beta-lactams, six to acetaminophen, and 19 to aspirin) and 64 drug-exposed nonallergic controls. Positive diagnosis was established by history, skin tests, and, if needed, oral provocation tests. Cys-LT release was determined after drug-allergen stimulation by the cellular antigen stimulation test (CAST(R)) technique. Histamine release was also assessed on the same samples by enzyme immunoassay. Spontaneous and anti-FcepsilonRIalpha-induced mediator release was also studied in all subjects. Sensitivity, specificity, and efficiency were calculated.
Results:
Net Cys-LT release was over the maximal threshold given by the manufacturer in 19/55 patients and in 9/64 controls. Net histamine release was over 5% of total histamine content in 28/55 patients and 34/64 controls. The efficiency of both tests was low.
Conclusion:
Thus, in most cases, the in vitro Cys-LT test has little or no diagnostic utility and is not superior to histamine release.
