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Updated: May 6, 2026
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
The relevance of basophil allergen sensitivity testing to distinguish between severe and mild peanut-allergic
Matjaž Homšak1, Mira Silar, Vojko Berce
1Department of Pediatrics, University Medical Center, Maribor, Slovenia.
Insights
Basophil allergen sensitivity testing accurately distinguishes severe peanut allergy in children. This cellular test, measuring basophil CD63 response (CD-sens), identifies children at risk for anaphylaxis, improving peanut allergy diagnosis.
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Cellular Immunology
Background:
- Peanut sensitization is prevalent in children, yet predicting reaction severity remains challenging.
- Differentiating mild peanut allergy from severe anaphylaxis requires improved diagnostic tools.
Purpose of the Study:
- To evaluate the effectiveness of basophil allergen sensitivity testing in distinguishing peanut allergy severity in children.
- To assess the correlation between basophil CD63 response and clinical manifestations of peanut allergy.
Main Methods:
- Twenty-seven peanut-sensitized children underwent peanut CD63 dose-response curve analysis, including basophil allergen sensitivity calculation (CD-sens).
- Peanut component-specific immunoglobulin E (IgE) testing was performed concurrently.
- Children were categorized based on symptom severity, from mild reactions to severe anaphylaxis.
Main Results:
- Children with a history of anaphylaxis exhibited significantly higher peanut CD63 responses and CD-sens values compared to those with milder reactions (p < 0.0001).
- A negative or low CD-sens value effectively excluded anaphylactic peanut allergy.
- Elevated IgE levels to specific peanut allergens (Ara h 1, 2, 3, 9) were observed in children with anaphylaxis, while IgE to Ara h 8 and whole peanut extract were comparable.
- CD-sens demonstrated 100% diagnostic specificity for identifying anaphylactic peanut allergy, outperforming Ara h 2 (73%).
Conclusions:
- Severe peanut allergy is strongly associated with heightened basophil allergen sensitivity.
- Basophil allergen sensitivity testing (CD-sens) offers a promising cellular method for accurate peanut allergy diagnosis and severity assessment in children.
Background:
Peanut sensitization is common in children. However, it is difficult to assess which children will react mildly and which severely. This study evaluated the relevance of basophil allergen sensitivity testing to distinguish the severity of peanut allergy in children.
Methods:
Twenty-seven peanut-sensitized children with symptoms varying from mild symptoms to severe anaphylaxis underwent peanut CD63 dose-response curve analysis with the inclusion of basophil allergen sensitivity calculation (CD-sens) and peanut component immunoglobulin E (IgE) testing.
Results:
Eleven children who had experienced anaphylaxis to peanuts showed a markedly higher peanut CD63 response at submaximal allergen concentrations and CD-sens (median 1,667 vs. 0.5; p < 0.0001) than 16 children who experienced a milder reaction. Furthermore, a negative or low CD-sens to peanuts unambiguously excluded anaphylactic peanut allergy. Children with anaphylaxis have higher levels of Ara h 1, 2, 3 and 9 IgE, but comparable levels of IgE to Ara h 8 and whole-peanut extract. The diagnostic specificity calculated with a receiver operating characteristic analysis reached 100% for CD-sens and 73% for Ara h 2.
Conclusions:
We demonstrated that severe peanut allergy is significantly associated with higher basophil allergen sensitivity. This cellular test should facilitate a more accurate diagnosis of peanut allergy.
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