The Basophil Activation Test in Allergy Diagnostics: Clinical Applications, Methodological Challenges, and Proposed...

Area of Science:

• Immunology
• Allergology
• Flow Cytometry

Background:

• The basophil activation test (BAT) is an in vitro functional assay for diagnosing immunoglobulin E-mediated allergic reactions.
• It assesses basophil activation markers via flow cytometry after allergen stimulation, gaining clinical importance in complex allergy cases.

Purpose of the Study:

• To review the diagnostic performance and clinical applications of BAT in various allergic conditions.
• To discuss immunological mechanisms, methodological aspects, and comparative data against conventional methods.
• To propose frameworks for integrating BAT into allergy diagnostics and managing specific patient groups.

Main Methods:

• Narrative review of current evidence on BAT.
• Discussion of immunological mechanisms (CD63, CD203c) and assay methodology.
• Analysis of diagnostic performance (sensitivity, specificity) and comparison with other tests.

Main Results:

• BAT demonstrates high specificity for diagnosing clinically relevant allergic reactions.
• The test is particularly useful in cases of anaphylaxis risk, polysensitization, drug hypersensitivity, and inconclusive conventional tests.
• Evidence supports BAT's role in food allergy, drug hypersensitivity, venom allergy, latex sensitization, and immunotherapy monitoring.

Conclusions:

• BAT is a valuable functional assay with high specificity for allergy diagnosis.
• Standardization, clear interpretation criteria, and addressing non-responder issues are crucial for optimal clinical integration.
• Future developments like multiplexing and automation may enhance BAT's role in personalized allergy diagnostics.