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Published on: November 16, 2016
[Cellular in-vitro assays. Applicability in daily routine]
1Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover. wedi.bettina@mh-hannover.de
Insights
Cellular allergy tests like the antigen stimulation test and basophil activation assay detect allergic reactions safely. These in-vitro methods aid diagnosis when conventional allergy tests are inconclusive or contraindicated.
Area of Science:
- Immunology
- Allergy Diagnostics
Context:
- In-vitro cellular assays offer a safe alternative to in-vivo allergy testing.
- Established models include the cellular antigen stimulation test and basophil activation assays for IgE-mediated reactions.
Purpose:
- To evaluate the diagnostic value of cellular in-vitro assays for allergy.
- To highlight their utility in specific clinical scenarios.
Summary:
- Cellular antigen stimulation tests (sulfidoleukotriene production) and flow cytometry basophil activation assays (CD63, CD203c) model mast cell activation.
- Standardization issues (allergen concentration, methods, cut-offs) hinder direct comparison of study results.
- These assays are valuable for diagnosing allergies to rare allergens or when skin/provocation tests are contraindicated.
Impact:
- Provides a safer diagnostic approach for immediate-type hypersensitivity reactions.
- Supports clinical decisions in complex allergy cases, including drug and insect venom allergies.
- Enhances allergy diagnosis for patients with contraindications to traditional testing methods.
Abstract:
Cellular in-vitro assays are able to detect antigen-dependent cellular processes without any risk for the patient. After antigen stimulation, both the cellular antigen stimulation test assessing sulfidoleukotriene production in leukocyte suspension, and flow cytometric basophil activation assays determining surface activation markers (CD63, CD203c), represent accepted models for in-vivo mast cell stimulation particularly in IgE-dependent reactions of immediate type. The value of these assays should be estimated considering the type of antigen and further diagnostic options. Most studies can not be compared due to different allergen concentrations, conditions of stimulation, methods, and defined cut-offs. Therefore, it is difficult to evaluate published evidence. Because of the logistic effort, cellular assays are often available only in specialized laboratories. However, in daily routine they are important in cases with clear-cut history but negative conventional allergy diagnostic procedures, in case of rare allergens (drugs, exotic food), as well as contraindications for skin and/or provocation test (hymenoptera venom allergy, anaphylaxis).
