Basophil Activation Test Application in Drug Hypersensitivity Diagnosis: An Empirical Approach

Area of Science:

• Immunology
• Clinical Pharmacology

Background:

• Diagnosis of drug hypersensitivity reactions (DHRs) relies on clinical history and in vivo tests.
• Specific IgE and cutaneous tests are used when available for DHR diagnosis.

Purpose of the Study:

• To evaluate the basophil activation test (BAT) as a supplementary tool for drug allergy diagnosis.
• To assess BAT's utility alongside drug challenges in identifying DHRs.

Main Methods:

• Evaluated 204 outpatients with reported DHRs.
• Performed serum-specific IgE, cutaneous tests, and basophil activation tests (BAT) using CD63 expression via flow cytometry.
• Drug challenges were conducted for patients with discrepancies or severe reactions.

Main Results:

• Antibiotics and NSAIDs were the most frequent causes of DHRs.
• BAT demonstrated high specificity (92%) for antibiotics but low sensitivity (40%).
• High specificity was observed for NSAIDs (100%) and penicillin allergy diagnosis (94% concordance with in vitro tests).

Conclusions:

• BAT is effective in discriminating adverse drug reactions.
• Concordance between clinical history and in vitro tests, including BAT, reduces the necessity for challenge testing.
• Integrated evaluations and complex clinical examinations are reserved for critical cases.