Drug hypersensitivity to vancomycin confirmed by basophil activation test: case report.

Area of Science:

• Immunology
• Allergy and Clinical Immunology
• Pharmacology

Background:

• Drug hypersensitivity reactions (DHRs) to vancomycin present diagnostic challenges, especially in pediatric patients with primary immunodeficiency.
• Immediate hypersensitivity reactions, including urticaria and angioedema, necessitate reliable diagnostic tools for effective management.

Observation:

• A 7-year-old girl with primary immunodeficiency exhibited immediate hypersensitivity to vancomycin, successfully managed with corticosteroids and antihistamines.
• Two years post-reaction, the Basophil Activation Test (BAT) demonstrated significant vancomycin-induced basophil activation (CD63 and CD203c expression).

Findings:

• The Basophil Activation Test (BAT) confirmed vancomycin hypersensitivity in the pediatric patient.
• The test showed robust basophil activation across all vancomycin concentrations, exceeding control levels.

Implications:

• The Basophil Activation Test (BAT) is a valuable in vitro diagnostic tool for confirming vancomycin hypersensitivity, particularly when skin testing or IgE assays are not feasible.
• This case supports the broader clinical adoption of BAT in allergy practice, especially in resource-limited settings, for managing drug hypersensitivity in high-risk populations.