Faculty of Medicine and Health Science, Department of Immunology - Allergology - Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium.
Faculty of Medicine and Health Science, Department of Immunology - Allergology - Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerpen, Belgium; The Infla-Med Centre of Excellence, Antwerp University, Antwerpen, Belgium.
J Allergy Clin Immunol Pract. 2023 Feb;11(2):500-505. doi: 10.1016/j.jaip.2022.10.050. Epub 2022 Nov 17.
In light of the pandemic of spurious penicillin allergy, correct diagnosis of amoxicillin (AX) allergy is of great importance. The diagnosis of immediate hypersensitivity reactions relies on skin tests and specific IgE, and although reliable, these are not absolutely predictive. Therefore, drug challenges are needed in some cases, which contain the risk of severe reactions. Safe in vitro diagnostics as an alternative for the drug challenge in the diagnostic workup of AX allergy would be more than welcome to fill this gap. In this respect, the basophil activation test (BAT) has shown potential, but its clinical reliability is doubtful.
To investigate the reliability of the BAT to AX and determining its exact place in the diagnostic algorithm of AX allergy.
BAT for AX was performed in 70 exposed control individuals and 66 patients diagnosed according to the European Academy of Allergy and Clinical Immunology guidelines for AX allergy. Upregulation of both CD63 and CD203c was flow-cytometrically assessed.
Analyses revealed that 1370 μmol/L and 685 μmol/L were the most discriminative stimulation concentrations for CD63 and CD203c upregulation, respectively, and a diagnostic threshold of 9% for positivity for both markers was identified. At these concentrations, sensitivity and specificity for CD63 upregulation were 13% and 100%, respectively, and for CD203c upregulation, 23% and 98%.
BAT with dual analysis of CD63 and CD203c is of poor performance to document AX allergy. The sensitivity is too low to let it occupy a prominent role in the diagnostic algorithm.
鉴于虚假青霉素过敏的流行，正确诊断阿莫西林（AX）过敏非常重要。速发型过敏反应的诊断依赖于皮肤试验和特异性 IgE，虽然可靠，但并非绝对预测。因此，在某些情况下需要进行药物挑战，这包含严重反应的风险。替代药物挑战的安全体外诊断作为 AX 过敏诊断评估中的一种方法，将非常受欢迎，以填补这一空白。在这方面，嗜碱性粒细胞活化试验（BAT）显示出了潜力，但其实用性的临床可靠性值得怀疑。
研究 BAT 对 AX 的可靠性，并确定其在 AX 过敏诊断算法中的确切位置。
在 70 名暴露于 AX 的对照个体和 66 名根据欧洲过敏与临床免疫学学会指南诊断为 AX 过敏的患者中进行了 AX 的 BAT。通过流式细胞术评估 CD63 和 CD203c 的上调。
分析表明，1370μmol/L 和 685μmol/L 分别是 CD63 和 CD203c 上调的最具区分力的刺激浓度，并且确定了两种标志物均为阳性的诊断阈值为 9%。在这些浓度下，CD63 上调的敏感性和特异性分别为 13%和 100%，而 CD203c 上调的敏感性和特异性分别为 23%和 98%。
使用 CD63 和 CD203c 的双重分析进行 BAT 对 AX 过敏的诊断性能较差。敏感性太低，无法使其在诊断算法中占据突出地位。
Zotero 插件