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ORIGINAL RESEARCH article

Front. Allergy
Sec. Drug, Venom & Anaphylaxis
Volume 5 - 2024 | doi: 10.3389/falgy.2024.1512875

Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics

Provisionally accepted
Markus Reitmajer Markus Reitmajer 1*Antonia Strauss Antonia Strauss 1Christian Klinger Christian Klinger 1Maximiliane Maaß Maximiliane Maaß 1Wolfgang E Kempf Wolfgang E Kempf 1,2Joerg Fischer Joerg Fischer 3Manfred Kneilling Manfred Kneilling 1,4Sebastian Volc Sebastian Volc 1
  • 1 Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
  • 2 FACS Core Facility Location Tal, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
  • 3 Department of Dermatology and Allergology, Augsburg University Hospital, Augsburg, Baden-Württemberg, Germany
  • 4 Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University, Tuebingen, Germany

The final, formatted version of the article will be published soon.

    Background: Allergy to beta-lactam antibiotics (BLA), especially to penicillin, is the most commonly reported drug allergy by patients. Alternative antibiotics, can yield negative consequences such as extended hospitalization days due to less efficacy and overall higher costs. The basophil activation test (BAT) is an in vitro assay, in which activation of individual's own basophils is quantified by flow cytometry. It is an increasingly applied in vitro method in allergy testing also gaining traction in drug allergies.We correlated 37 BAT results with skin test results. The cohort included exclusively patients with suspected type I BLA allergy. Additionally, we examined the concordance of these results with clinical symptoms reported in the BLA patients' medical histories.Results: BLA-BAT revealed a high specificity of 92.3% (95% CI 66.7-98.6) but a low sensitivity of only 20.8% (95% CI 9.24-40.47) using BLA-skin tests as a comparator. Negative BLA-BAT in patients with history of grade I anaphylaxis yielded doubt on the assumption of grading. Exclusion of grade I BLA anaphylaxis increased the sensitivity to 29.4% (95% CI 13.28-53.13) with a still high specificity of 85.7% (95% CI 48.69-97.43). When ImmunoCAP was available, we compared specific IgE-and BAT results by using Cohens's kappa (k) and revealed a moderate level of agreement (k = 0.538, p = 0.029).BAT reveals specific positive results exclusively in patients with cephalosporine anaphylaxis. However, these findings could not be generally confirmed in the heterogeneous group of BLA.basophil activation test (BAT).

    Keywords: beta-lactam-antibiotic, Basophil Activation Test, Type 1 allergy, Hypersensitivity, Delabeling

    Received: 17 Oct 2024; Accepted: 06 Dec 2024.

    Copyright: © 2024 Reitmajer, Strauss, Klinger, Maaß, Kempf, Fischer, Kneilling and Volc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Markus Reitmajer, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.