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Updated: Dec 6, 2025
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Two Different Composite Markers Predict Severity and Threshold Dose in Peanut Allergy
Nathalie Cottel1, Sarah Saf1, Melisande Bourgoin-Heck2
1Allergology Department, Hôpital A. Trousseau, Sorbonne Université, AP-HP, Paris, France.
Insights
Researchers identified biological markers to assess peanut allergy (PA) severity during oral food challenges (OFCs). Specific IgE and basophil activation tests can predict severe reactions and threshold doses in children with PA.
Area of Science:
- Allergy and Immunology
- Pediatric Clinical Research
- Diagnostic Biomarker Development
Background:
- Lack of reliable biological markers for evaluating peanut allergy (PA) severity and threshold doses during oral food challenges (OFCs).
- Need for cost-effective and safe surrogate markers to predict allergic reaction intensity.
Purpose of the Study:
- To identify and evaluate biological markers correlating with allergic reaction severity and threshold dose in children undergoing peanut OFC.
- To assess the diagnostic accuracy of these markers in a pediatric PA population.
Main Methods:
- Collected demographic and biological data from children undergoing peanut OFC, including basophil activation test (BAT) results.
- Stratified patients into severity groups (mild-to-moderate vs. severe) and cumulative threshold dose groups (low ≤100 mg vs. high >100 mg).
- Analyzed correlations between markers like Ara h 2-specific IgE, FcεRI, and fMLP-positive controls with reaction severity and threshold dose.
Main Results:
- High concordance (96%) between OFC and BAT for PA diagnosis.
- Higher Ara h 2-specific IgE and FcεRI-positive control values correlated with severe peanut allergic reactions.
- A 2-marker combination (IgE, FcεRI) showed 92% sensitivity and 82% specificity for severe reactions.
- A 4-variable composite marker demonstrated 97% sensitivity and 61% specificity for low cumulative threshold dose in children.
Conclusions:
- Composite markers, incorporating both allergen-specific and non-allergen-specific basophil activation test parameters, are associated with peanut allergy severity and threshold dose in children.
- These findings suggest potential for improved prediction of reaction severity and dose thresholds in pediatric PA.
Background:
Safe and cost-effective biological surrogate markers to evaluate the severity and threshold dose of peanut allergy (PA) reactions during an oral food challenge (OFC) are lacking.
Objective:
To evaluate biological markers associated with the severity and threshold dose of an allergic reaction during an OFC in a population of children with PA.
Methods:
Demographic and biological parameters of children with peanut OFC and basophil activation test (BAT) results were collected. Patients were stratified into 2 severity groups (mild-to-moderate and severe) and 2 cumulative threshold dose groups: low (LCTG) ≤100 mg crushed peanut and high >100 mg.
Results:
Among the 68 children included, there was a 96% concordance between the OFC and BAT result for the diagnosis of PA. Of the 56 children with a positive OFC and BAT to peanut (median age: 8.8 years), the severity of an allergic reaction and the cumulative threshold dose were not correlated (P = .24). Higher Ara h 2-specific IgE and FcεRI-positive control values were both associated with severe reactions to peanut. Combining these 2 markers led to a 92% sensitivity (84%-97%) and an 82% specificity (71%-89%) for severe reactions in all subjects. For children in the LCTG, a 4-variable composite marker, including age, normalized basophil sensitivity (EC50), and FcεRI- and fMLP-positive control values, resulted in a 97% sensitivity (89%-99%) and 61% specificity (49%-71%).
Conclusion:
Distinct composite markers including BAT allergen-specific and non-allergen-specific parameters appear to be associated with severity and cumulative threshold dose in children with PA.
