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Koumaki D, Gregoriou S, Evangelou G, Katoulis A, Papadakis M, Krueger-Krasagakis SE, Doxastaki A, Mylonakis D, Krasagakis K. Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions. Dermatol Ther (Heidelb) 2023; 13:3229-3239. [PMID: 38015412 PMCID: PMC10689598 DOI: 10.1007/s13555-023-01069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The basophil activation test (BAT) is a flow cytometry laboratory technique that assesses the level of activation indicators expressed on the surface of basophils. We conducted a real-life study in a prospective cohort of patients with reported drug hypersensitivity reactions to determine the true relevance of BAT as a diagnostic tool for assessing immediate hypersensitivity reactions to medicines. METHODS We prospectively assessed individuals with clinical suspicion of immediate hypersensitivity reactions to drugs over a 2-year period. The allergological evaluation was carried out in accordance with European Academy of Allergy and Clinical Immunology (EAACI) guidance. All patients underwent BAT using the activation marker CD63. RESULTS In total 13 patients with 54 reported immediate drug hypersensitivity reactions to medications were included in this study. Twelve were female (92.3%) and one was male (7.70%). The mean ± SD age of the patients was 47.31 ± 19.94 years. Antibiotics were tested in 35.2% (19/54) of patients, corticosteroids in 24.1% (13/54), iodinated contrast medium in 14.8% (8/54), and NSAIDs in 5.6% (3/54). There was no correlation between the BAT results and the age of patients, gender, type of medication, or time interval between the allergic reaction and BAT procedure. The sensitivity of BAT 5% CD63+ basophils to drugs was 97.6%, specificity was 96% for drug allergies, positive predictive value (PPV) was 94.3%, and negative predictive value (NPV) was 95.2%. CONCLUSIONS The sensitivity of BAT for drug allergies is limited, but it can nevertheless be very helpful before contemplating provocation testing in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of medications for which no other tests are available or their results are ambiguous.
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece.
| | - Stamatios Gregoriou
- Department of Dermatology and Venereology, Medical School of Athens, Andreas Sygros Hospital, National and Kapodistrian University of Athens, I. Dragoumi 5, 161 21, Athens, Greece
| | - Georgios Evangelou
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Heusnerstrasse 40, 42283, Witten, Germany
| | | | - Aikaterini Doxastaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Dimitrios Mylonakis
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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Charpy J, Barbier O, Le Mauff B, Sarrat A, Roland-Nicaise P, Goret J. Basophil activation test: Feedback and lessons from routine practice in French clinical laboratories. Clin Exp Allergy 2023; 53:1055-1058. [PMID: 37366346 DOI: 10.1111/cea.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Juliette Charpy
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
- AllergoBioNet network, Angers, France
| | - Ophélie Barbier
- Allergoly Unit, Bordeaux University Hospital, Bordeaux, France
| | - Brigitte Le Mauff
- AllergoBioNet network, Angers, France
- Department of Immunology, Caen University Hospital, Caen, France
| | - Anne Sarrat
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
- AllergoBioNet network, Angers, France
| | - Pascale Roland-Nicaise
- AllergoBioNet network, Angers, France
- Department of Immunology, Paris Nord Val de Seine University Hospital, Bichat Hospital, Paris, France
| | - Julien Goret
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
- AllergoBioNet network, Angers, France
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Alpan O, Wasserman RL, Kim T, Darter A, Shah A, Jones D, McNeil D, Li H, Ispas L, Rathkopf M, Perez E, Siri D, O’Connor M, Plassmeyer M, Romito K, Pettibone C, O’Reilly S, Sønder SU, Marti G. Towards an FDA-cleared basophil activation test. FRONTIERS IN ALLERGY 2023; 3:1009437. [PMID: 36698379 PMCID: PMC9869275 DOI: 10.3389/falgy.2022.1009437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Food allergy is a global health problem affecting up to 10% of the world population. Accurate diagnosis of food allergies, however, is still a major challenge in medical offices and for patients seeking alternative avenues of diagnosis. A flawless test to confirm or rule out a food allergy does not exist. The lack of optimum testing methods to establish precise clinical correlations remains a major obstacle to effective treatment. Certain IgE measurement methods, including component testing, have received FDA clearance, but they have been used primarily as an analytical tool and not to establish clinical correlations. Most allergy tests are still carried out within the laboratory, and skin tests outside a laboratory setting that are used for food allergy diagnosis rely on non-standardized allergens, according to the FDA definition. Epitope mapping and basophil activation test (BAT) have recently been proposed as a means of establishing better clinical correlations. Yet neither have received FDA clearance for widespread distribution. Of the two methods, the BAT has the advantage of being a functional assay. Over the past few years, several large private practice groups in the United States, have developed BAT as a clinical assay and have started using it in patient care. Given this clinical experience, the vast number of papers published on BAT (more than 1,400 as of 2022) and the trend toward increasing FDA regulation, it is essential to understand the roadmap for regulatory clearance of this assay.
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Affiliation(s)
- Oral Alpan
- Amerimmune, Fairfax, VA, United States,Correspondence: Oral Alpan
| | | | - Theodore Kim
- Allergy Partners of Northern Virginia, Chantilly, VA, United States
| | - Amy Darter
- Oklahoma Institute of Allergy, Asthma and Immunology, Oklahoma City, OK, United States
| | - Atul Shah
- New York Food Allergy and Wellness Center, Centereach, NY, United States
| | | | | | - Henry Li
- Institute for Asthma and Allergy, Wheaton, MD, United States
| | - Laura Ispas
- Allergy, Asthma and Immunology Institute, Leesburg, VA, United States
| | - Melinda Rathkopf
- Allergy Asthma and Immunology Center of Alaska, Anchorage, AK, United States
| | - Elena Perez
- Allergy Associates of the Palm Beaches, Palm Beach, FL, United States
| | - Dareen Siri
- Midwest Allergy Sinus Asthma, Normal, IL, United States
| | - Maeve O’Connor
- Allergy, Asthma and Immunology Relief of Charlotte, Charlotte, NC, United States
| | | | | | | | - Sean O’Reilly
- New Columbia Capital, LLC, Arlington, VA, United States
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4
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Sonder SU, Plassmeyer M, Loizou D, Alpan O. Towards standardizing basophil identification by flow cytometry. FRONTIERS IN ALLERGY 2023; 4:1133378. [PMID: 36938328 PMCID: PMC10020589 DOI: 10.3389/falgy.2023.1133378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background Basophils normally make up <2% of the white blood cells (WBC). There is no clear consensus for basophil identification by flow cytometry. The increased demand for basophil activation test (BAT) to identifying and monitoring allergic patients highlights the need for a standardized approach to identify basophils. Methods Using flow cytometry we analyzed whole blood stained with antibodies against: IgE, CD123, CD193, CD203c, CD3, HLADR, FcɛRI, CRTH2 and CD45. We examined unstimulated blood as well as blood stimulated with Anti-IgE and fMLP. Finally, we compared the results to a complete blood count (CBC) from an FDA approved hematological analyzer. Results Basophil identification relying on just one surface marker performed worse than approaches utilizing two identification markers. The percentage of basophils from WBC determined by flow cytometry results had a good correlation with the CBC results even though the CBC results were generally higher. Stimulating whole blood with the basophil activators did not interfere with the basophil identification markers. Conclusion In flow cytometry assays, two surface markers should be used for identifying basophils and if a very pure basophil fraction is desired a third marker can be considered. In our hands the approaches that included CD123 in combination with either CD193, HLADRnegative or FcɛRI performed the best.
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Behrends J, Schwager C, Hein M, Scholzen T, Kull S, Jappe U. Innovative robust basophil activation test using a novel gating strategy reliably diagnosing allergy with full automation. Allergy 2021; 76:3776-3788. [PMID: 33973252 DOI: 10.1111/all.14900] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Allergy is one of the most common chronic diseases in Europe. Therefore, an increased need for specific and sensitive diagnostic tests that truly detect allergy exists. This study aimed at establishing a highly specific high-throughput and automated basophil activation test (BAT) that proves the existence of an allergy with utmost probability. METHODS BAT from 1104 samples was analyzed; a novel gating strategy with three antibodies (FcεRIα, CD203c, CD63) was established and compared with our published protocol (12 antibodies). Based on the novel gating strategy, storage conditions, automated measurement, and analyses using R (1376 samples out of 1389) were optimized to set up a high-throughput BAT. RESULTS No differences in sensitivity and specificity were found between the novel three antibody (FcεRIα, CD203c, CD63) and the 12 antibody gating strategy or between automated and manually analyzed samples (saving up to 90% of labor time). The time frame for basophil activation measurement after blood donation has been extended considerably (whole blood storage ≤7 days (RT) and 17 days (4°C) prior to BAT preparation and measurement). Respective storage conditions were optimized for samples after stimulation, staining, and preparation (≤7 days (RT) and 28 days (4°C)). These achievements were confirmed by a nationwide ring trial showing robustness and applicability of our BAT on a variety of flow cytometers. CONCLUSION Our considerable optimizations overcame the hurdles that until now prevented the BAT from being used as high-throughput allergy diagnostic test in routine laboratories and shall allow for collaborative studies between clinics and research centers.
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Affiliation(s)
- Jochen Behrends
- Core Facility Fluorescence Cytometry Research Center Borstel Leibniz Lung Center Borstel Germany
| | - Christian Schwager
- Division of Clinical and Molecular Allergology Priority Area Asthma and Allergy Airway Research Center North (ARCN) German Center for Lung Research (DZL Borstel Germany
| | - Martina Hein
- Core Facility Fluorescence Cytometry Research Center Borstel Leibniz Lung Center Borstel Germany
| | - Thomas Scholzen
- Core Facility Fluorescence Cytometry Research Center Borstel Leibniz Lung Center Borstel Germany
| | - Skadi Kull
- Division of Clinical and Molecular Allergology Priority Area Asthma and Allergy Airway Research Center North (ARCN) German Center for Lung Research (DZL Borstel Germany
| | - Uta Jappe
- Division of Clinical and Molecular Allergology Priority Area Asthma and Allergy Airway Research Center North (ARCN) German Center for Lung Research (DZL Borstel Germany
- Interdisciplinary Allergy Outpatient Clinic Department of Pneumology University of Lübeck Lübeck Germany
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Briceno Noriega D, Teodorowicz M, Savelkoul H, Ruinemans-Koerts J. The Basophil Activation Test for Clinical Management of Food Allergies: Recent Advances and Future Directions. J Asthma Allergy 2021; 14:1335-1348. [PMID: 34754200 PMCID: PMC8572092 DOI: 10.2147/jaa.s237759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
The basophil activation test (BAT) is an ex vivo functional assay that measures by flow cytometry the degree of basophil degranulation after stimulation with an allergen. In recent years, there has been an increased interest in the diagnostic value of the BAT as it has the potential to mimic the clinical phenotype of sIgE sensitized patients, in contrast to allergen-specific IgE levels. This diagnostic potential would be of particular interest for food allergies present early in life such as peanut, cow’s milk and eggs, which require an expensive, time-consuming and patient unfriendly oral food challenge (OFC) for diagnosis. However, routine applications of the BAT for clinical use are not yet feasible due to the lack of standardized protocols and large clinical validation studies. This review will summarize the current data regarding the application of the BAT in food allergy (FA) for cow’s milk, egg and peanut, being the most common causes of FA in children. Additionally, it will discuss the hurdles for widespread clinical use of the BAT and possible future directions for this diagnostic procedure.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands.,Laboratory of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, the Netherlands
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8
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Gabler AM, Gebhard J, Eberlein B, Biedermann T, Scherf KA, Brockow K. The basophil activation test differentiates between patients with wheat-dependent exercise-induced anaphylaxis and control subjects using gluten and isolated gluten protein types. Clin Transl Allergy 2021; 11:e12050. [PMID: 34386193 PMCID: PMC8340350 DOI: 10.1002/clt2.12050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/17/2021] [Accepted: 07/21/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Oral food challenge using gluten and cofactors is the gold standard to diagnose wheat-dependent exercise-induced anaphylaxis (WDEIA), but this procedure puts patients at risk of an anaphylactic reaction. Specific IgE to ω5-gliadins as major allergens and skin prick tests to wheat may yield negative results. Thus, we designed a proof-of-principle study to investigate the utility of the basophil activation test (BAT) for WDEIA diagnosis. METHODS Different gluten protein types (GPT; α-, γ-, ω1,2- and ω5-gliadins, high-molecular-weight glutenin subunits [HMW-GS] and low-molecular-weight glutenin subunits [LMW-GS]) and gluten were used in different concentrations to measure basophil activation in 12 challenge-confirmed WDEIA patients and 10 control subjects. The results were compared to routine allergy diagnostics. Parameters analyzed include the percentage of CD63+ basophils, the ratio of %CD63+ basophils induced by GPT/gluten to %CD63+ basophils induced by anti-FcεRI antibody, area under the dose-response curve and test sensitivity and specificity. RESULTS GPT and gluten induced strong basophil activation for %CD63+ basophils and for %CD63+/anti-FcɛRI ratio in a dose-dependent manner in patients, but not in controls (p < 0.001, respectively). BAT performance differed from acceptable (0.73 for LMW-GS) to excellent (0.91 for ω5-gliadins) depending on the specific GPT as evaluated by the area under the receiver operating characteristic curve. Patients showed individual sensitization profiles. After determination of the best cut-off points, ω5-gliadins and HMW-GS showed the best discrimination between patients and controls with a sensitivity/specificity of 100/70 and 75/100, respectively. CONCLUSION This study shows the alternative role of BAT in better defining WDEIA and the causative wheat allergens. The best BAT parameters to distinguish WDEIA patients from controls were %CD63+ basophil values for ω5-gliadins and HMW-GS.
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Affiliation(s)
- Angelika Miriam Gabler
- Leibniz‐Institute for Food Systems Biology at the Technical University of MunichFreisingGermany
| | - Julia Gebhard
- Department of Dermatology and Allergy BiedersteinTUM School of MedicineTechnical University of MunichMunichGermany
| | - Bernadette Eberlein
- Department of Dermatology and Allergy BiedersteinTUM School of MedicineTechnical University of MunichMunichGermany
| | - Tilo Biedermann
- Department of Dermatology and Allergy BiedersteinTUM School of MedicineTechnical University of MunichMunichGermany
| | - Katharina Anne Scherf
- Leibniz‐Institute for Food Systems Biology at the Technical University of MunichFreisingGermany
- Department of Bioactive and Functional Food ChemistryInstitute of Applied BiosciencesKarlsruhe Institute of Technology (KIT)KarlsruheGermany
| | - Knut Brockow
- Department of Dermatology and Allergy BiedersteinTUM School of MedicineTechnical University of MunichMunichGermany
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9
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Zhong Q, Zhan M, Wang L, Chen D, Zhao N, Wang J, Huang Y, Zhang X, He S, Zhang H. Upregulation of the expression of Toll-like receptor 9 in basophils in patients with allergic rhinitis: An enhanced expression by allergens. Scand J Immunol 2020; 93:e13003. [PMID: 33247440 DOI: 10.1111/sji.13003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/09/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022]
Abstract
It was reported that the expression of Toll-like receptor (TLR) 9 may be related to Th2-type allergic inflammation including allergic rhinitis (AR). However, little is known about the expression of TLR9 in the basophils in AR. In the present study, the expression of TLR9 was examined by flow cytometry analysis, and the expression of TLR9 mRNA in KU812 was determined by quantitative real-time PCR. The results showed that the percentage of TLR9+ CCR3+ cells in blood granulocytes increased by 46% in patients with AR, but not in peripheral blood mononuclear cells (PBMCs). Allergens namely Dermatophagoide allergen extract (DAE) and Platanus pollen allergen extract (PPAE) upregulated the expression of TLR9 in CCR3+ granulocytes by 76% and 84%, respectively. DAE and PPAE also enhanced the proportions of TLR9+ CD123+ HLA-DR- cells and TLR9+ CCR3+ CD123+ HLA-DR- cells in granulocytes and PBMCs of patients with AR. In order to investigate the actions of allergens on basophils, KU812 cells were used. It was observed that all KU812 cells expressed TLR9, and the expression intensity of TLR9 in a single KU812 cell was elevated by CpG. IL-37, IL-31, IL-33, Artemisia sieversiana wild allergen extract (ASWAE), DAE, OVA and Der p 1 induced an increase in the expression of TLR9 mRNA and IL-6 production in KU812 cells. It was shown that the percentage of TLR9-expressing basophils increased in the blood of ovalbumin (OVA)-sensitized mice. In conclusion, an increased expression of TLR9 and the production of IL-6 in basophils implicate that the contribution of basophils to AR is likely via TLR9.
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Affiliation(s)
- Qing Zhong
- Department of Pathophysiology, Translational Medicine Institute, Shenyang Medical College, Shenyang, China
| | - Mengmeng Zhan
- Department of Pathophysiology, Translational Medicine Institute, Shenyang Medical College, Shenyang, China
| | - Ling Wang
- Department of Pathophysiology, Translational Medicine Institute, Shenyang Medical College, Shenyang, China
| | - Dong Chen
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Nan Zhao
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Junling Wang
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yixia Huang
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xiaowen Zhang
- Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Shaoheng He
- Department of Pathophysiology, Translational Medicine Institute, Shenyang Medical College, Shenyang, China.,Allergy and Clinical Immunology Research Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huiyun Zhang
- Department of Pathophysiology, Translational Medicine Institute, Shenyang Medical College, Shenyang, China
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Hemmings O, Kwok M, McKendry R, Santos AF. Basophil Activation Test: Old and New Applications in Allergy. Curr Allergy Asthma Rep 2018; 18:77. [PMID: 30430289 PMCID: PMC6244909 DOI: 10.1007/s11882-018-0831-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The basophil activation test (BAT) using flow cytometry has supplanted traditional methods of measuring basophil degranulation using histamine and other mediator release, and can be used for clinical applications as well as to explore the immune mechanisms of effector cell response to allergen. This review discusses the advancements made in clinical, diagnostic and laboratory research of allergy utilizing an ever-evolving BAT. RECENT FINDINGS Being an in vitro surrogate of the allergic reaction that happens in vivo in the sick patient, the BAT can be used to support the diagnosis of various allergic conditions, such as food, drug, respiratory and insect venom allergies, and the assessment of clinical response to allergen-specific immunotherapy and other immunomodulatory treatments. The BAT can also be used for research purposes to explore the mechanisms of allergy and tolerance at the level of the basophil, for instance by manipulating IgE and IgG and their receptors and by studying intracellular signalling cascade in response to allergen. This review covers the applications of the BAT to the clinical management of allergic patients and the increased understanding of the mechanisms of immune response to allergens as well as technological advancements made in recent years.
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Affiliation(s)
- Oliver Hemmings
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Matthew Kwok
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Richard McKendry
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK. .,Children's Allergies Department, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, UK.
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11
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Renand A, Shamji MH, Harris KM, Qin T, Wambre E, Scadding GW, Wurtzen PA, Till SJ, Togias A, Nepom GT, Kwok WW, Durham SR. Synchronous immune alterations mirror clinical response during allergen immunotherapy. J Allergy Clin Immunol 2018; 141:1750-1760.e1. [PMID: 29128670 PMCID: PMC5938141 DOI: 10.1016/j.jaci.2017.09.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/25/2017] [Accepted: 09/18/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Three years of treatment with either sublingual or subcutaneous allergen immunotherapy has been shown to be effective and to induce long-term tolerance. The Gauging Response in Allergic Rhinitis to Sublingual and Subcutaneous Immunotherapy (GRASS) trial demonstrated that 2 years of treatment through either route was effective in suppressing the response to nasal allergen challenge, although it was insufficient for inhibition 1 year after discontinuation. OBJECTIVE We sought to examine in the GRASS trial the time course of immunologic changes during 2 years of sublingual and subcutaneous immunotherapy and for 1 year after treatment discontinuation. METHODS We performed multimodal immunomonitoring to assess allergen-specific CD4 T-cell properties in parallel with analysis of local mucosal cytokine responses induced by nasal allergen exposure and humoral immune responses that included IgE-dependent basophil activation and measurement of serum inhibitory activity for allergen-IgE binding to B cells (IgE-facilitated allergen binding). RESULTS All 3 of these distinct arms of the immune response displayed significant and coordinate alterations during 2 years of allergen desensitization, followed by reversal at 3 years, reflecting a lack of a durable immunologic effect. Although frequencies of antigen-specific TH2 cells in peripheral blood determined by using HLA class II tetramer analysis most closely paralleled clinical outcomes, IgE antibody-dependent functional assays remained inhibited in part 1 year after discontinuation. CONCLUSION Two years of allergen immunotherapy were effective but insufficient for long-term tolerance. Allergen-specific TH2 cells most closely paralleled the transient clinical outcome, and it is likely that recurrence of the T-cell drivers of allergic immunity abrogated the potential for durable tolerance. On the other hand, the persistence of IgE blocking antibody 1 year after discontinuation might be an early indicator of a protolerogenic mechanism.
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Affiliation(s)
- Amedee Renand
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Mohamed H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | | | | | - Erik Wambre
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Guy W Scadding
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Stephen J Till
- Asthma, Allergy and Lung Biology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom; MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Gerald T Nepom
- Benaroya Research Institute at Virginia Mason, Seattle, Wash; Immune Tolerance Network, Bethesda, Md
| | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Stephen R Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
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12
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Patil SU, Calatroni A, Schneider M, Steinbrecher J, Smith N, Washburn C, Ma A, Shreffler WG. Data-driven programmatic approach to analysis of basophil activation tests. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:667-673. [PMID: 28618453 DOI: 10.1002/cyto.b.21537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/27/2017] [Accepted: 06/07/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Conventional data analysis of flow cytometry-based basophil activation testing requires repetitive, labor-intensive analysis that hampers efforts to standardize testing for clinical applications. Using an open-source platform, we developed and implemented a programmatic approach to the analysis of the basophil activation test (BAT) by flow cytometry. METHODS Using the BÜHLMANN FlowCAST® assay, peripheral blood from peanut allergic patients undergoing oral immunotherapy was incubated with peanut allergens (Arah1, Arah2, Arah6, whole peanut extract) and stained with fluorescent antibodies to CCR3 and CD63 for the development of a data-driven programmatic analysis using Bioconductor and R. Basophil identification using clustering and classification was validated using manually gated comparisons in an experimental subset. Reproducibility of CD63 upregulation set on unstimulated or anti-FcERI stimulated basophils was compared. RESULTS BAT analysis of 294 experiments was successful in 91.5% using the above approach, with a total of 7,166 individual basophil activation tests from 269 experiments. We estimate this represents a net saving of 1340 min of labor by a skilled operator. Medium-based gating correlated to respective manual gating more closely than anti-FcERI based gating (R = 0.96 vs. R = 0.84, P < 0.001). Only 2% of the basophil activation results were significantly different from manual gating. Quality measures of the experiments and other measures of basophil activation were also provided by the analysis. CONCLUSIONS We present a novel data-driven flow cytometric platform for the analysis of clinical basophil activation testing, providing a high throughput objective approach to basophil activation analysis. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Sarita U Patil
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Johanna Steinbrecher
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal Smith
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cecilia Washburn
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex Ma
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Depince-Berger AE, Sidi-Yahya K, Jeraiby M, Lambert C. Basophil activation test: Implementation and standardization between systems and between instruments. Cytometry A 2017; 91:261-269. [DOI: 10.1002/cyto.a.23078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/16/2017] [Accepted: 01/30/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - Khaled Sidi-Yahya
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
| | - Mohammed Jeraiby
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
| | - Claude Lambert
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
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14
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Klein O, Ngo-Nyekel F, Stefanache T, Torres R, Salomonsson M, Hallgren J, Rådinger M, Bambouskova M, Campbell M, Cohen-Mor S, Dema B, Rose CG, Abrink M, Charles N, Ainooson G, Paivandy A, Pavlova VG, Serrano-Candelas E, Yu Y, Hellman L, Jensen BM, Van Anrooij B, Grootens J, Gura HK, Stylianou M, Tobio A, Blank U, Öhrvik H, Maurer M. Identification of Biological and Pharmaceutical Mast Cell- and Basophil-Related Targets. Scand J Immunol 2017; 83:465-72. [PMID: 27028428 DOI: 10.1111/sji.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/27/2016] [Indexed: 01/09/2023]
Affiliation(s)
- O Klein
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - F Ngo-Nyekel
- Inserm UMRS-1149, Paris, France.,CNRS ERL 8252, Paris, France.,Sorbonne Paris Cite, Laboratoire d'excellence INFLAMEX, Université Paris Diderot, Paris, France
| | - T Stefanache
- Department of Periodontology, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - R Torres
- Safety and Sustainability Division, Leitat Technological Center, Barcelona, Spain
| | - M Salomonsson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - J Hallgren
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - M Rådinger
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Bambouskova
- Department of Signal Transduction, Institute of Molecular Genetics, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - M Campbell
- Institute of Inflammation and Repair and MCCIR, University of Manchester, Manchester, UK
| | - S Cohen-Mor
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - B Dema
- Inserm UMRS-1149, Paris, France.,CNRS ERL 8252, Paris, France.,Sorbonne Paris Cite, Laboratoire d'excellence INFLAMEX, Université Paris Diderot, Paris, France
| | - C G Rose
- Bioengineering, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK.,Immunopharmacology Group, Clinical Experimental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - M Abrink
- Section of Immunology, Department of Biomedical Sciences and Veterinary Public Health, VHC, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - N Charles
- Inserm UMRS-1149, Paris, France.,CNRS ERL 8252, Paris, France.,Sorbonne Paris Cite, Laboratoire d'excellence INFLAMEX, Université Paris Diderot, Paris, France
| | - G Ainooson
- Institute of Toxicology and Genetics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - A Paivandy
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - V G Pavlova
- Department of Experimental Morphology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - E Serrano-Candelas
- Biochemistry Unit, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Y Yu
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - L Hellman
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - B M Jensen
- Allergy Clinic, Copenhagen University Hospital - Gentofte Hospital, Hellerup, Denmark
| | - B Van Anrooij
- Department of Allergology, Groningen Research Institute of Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Grootens
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - H K Gura
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M Stylianou
- Antifungal Immunity Group, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - A Tobio
- Inserm UMRS-1149, Paris, France.,CNRS ERL 8252, Paris, France.,Sorbonne Paris Cite, Laboratoire d'excellence INFLAMEX, Université Paris Diderot, Paris, France
| | - U Blank
- Inserm UMRS-1149, Paris, France.,CNRS ERL 8252, Paris, France.,Sorbonne Paris Cite, Laboratoire d'excellence INFLAMEX, Université Paris Diderot, Paris, France
| | - H Öhrvik
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité -Universitätsmedizin, Berlin, Germany
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15
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The Evolution of Human Basophil Biology from Neglect towards Understanding of Their Immune Functions. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8232830. [PMID: 28078302 PMCID: PMC5204076 DOI: 10.1155/2016/8232830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/16/2016] [Indexed: 12/03/2022]
Abstract
Being discovered long ago basophils have been neglected for more than a century. During the past decade evidence emerged that basophils share features of innate and adaptive immunity. Nowadays, basophils are best known for their striking effector role in the allergic reaction. They hence have been used for establishing new diagnostic tests and therapeutic approaches and for characterizing natural and recombinant allergens as well as hypoallergens, which display lower or diminished IgE-binding activity. However, it was a long way from discovery in 1879 until identification of their function in hypersensitivity reactions, including adverse drug reactions. Starting with a historical background, this review highlights the modern view on basophil biology.
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16
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Béné MC, Le Bris Y, Robillard N, Wuillème S, Fouassier M, Eveillard M. Flow cytometry in hematological nonmalignant disorders. Int J Lab Hematol 2015; 38:5-16. [PMID: 26542092 DOI: 10.1111/ijlh.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
Abstract
Multiparameter flow cytometry (MFC) has become an integral part of the diagnosis and classification of hematological malignancies. However, several nonmalignant or premalignant disorders may benefit from this technology in hematology laboratories. This review provides information on the normal immunophenotypic characteristics of peripheral blood leukocyte subsets and their modifications in several clinical conditions. The usefulness of MFC and the specific markers that can be investigated in hyperlymphocytosis, infection, hypereosinophilia, paroxysmal nocturnal hemoglobinuria, and large granular lymphocyte disorders is described. Mention is also made of the developments of MFC for analyses of red blood cells or platelets.
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Affiliation(s)
- M C Béné
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - Y Le Bris
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - N Robillard
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - S Wuillème
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - M Fouassier
- Hematology Biology, University Hospital of Nantes, Nantes, France
| | - M Eveillard
- Hematology Biology, University Hospital of Nantes, Nantes, France
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17
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Pignatti P, Yacoub MR, Testoni C, Pala G, Corsetti M, Colombo G, Meriggi A, Moscato G. Evaluation of basophil activation test in suspected food hypersensitivity. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 92:279-285. [DOI: 10.1002/cyto.b.21264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Mona-Rita Yacoub
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Claudia Testoni
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianni Pala
- Occupational Physician's Division, Local Health Authority of Sassari; Sassari Italy
| | - Maura Corsetti
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID); University of Leuven; Leuven Belgium
| | - Giselda Colombo
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Antonio Meriggi
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianna Moscato
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
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