1
|
Preffer FI. Issue Highlights - November 2020. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 98:461-463. [PMID: 33245614 DOI: 10.1002/cyto.b.21972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 09/12/2020] [Accepted: 10/09/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Frederic I Preffer
- Professor of Pathology Harvard Medical School, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
2
|
Elst J, Sabato V, van der Poorten MLM, Van Gasse AL, Van Houdt M, Bridts CH, Walschot M, Timmermans JP, Pintelon I, Mertens C, Ebo DG. Basophil and mast cell activation tests by flow cytometry in immediate drug hypersensitivity: Diagnosis and beyond. J Immunol Methods 2021; 495:113050. [PMID: 33933471 DOI: 10.1016/j.jim.2021.113050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 01/01/2023]
Abstract
Immediate drug hypersensitivity reactions (IDHRs) constitute a significant health issue with serious consequences of diagnostic error. The primary diagnostics to document IDHRs usually consists of quantification of drug-specific IgE (sIgE) antibodies and skin tests. Unfortunately, the positive predictive value (PPV) and negative predictive value (NPV) of these tests are not absolutely, which leaves room for new tests. Over the last two decades, the basophil activation test (BAT), in which ex vivo activation of individual basophils is quantified by flow cytometry, has emerged as a reliable complementary diagnostic to document IDHRs, to explore allergenic recognition, to study cross-reactivity and to monitor therapy. However, the BAT is technically challenging requiring specialized personnel and equipment, fresh samples and the technique is lost as a diagnostic in patients showing a non-responder status of their cells. By consequence, the BAT has still not entered mainstream application. In contrast, mast cell activation tests (MATs) use serum samples that can be frozen, stored, and shipped to a recognized reference centre experienced in mast cell (MC) lines and/or cultures and capable of offering batch testing with necessary quality controls. This review does not only highlight the use of the BAT and MAT as diagnostics in IDHRs, but also outlines the potential of both techniques in further exploring and unveiling the mechanisms that govern drug-induced basophil and MC activation and degranulation.
Collapse
Affiliation(s)
- Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology, AZ Jan Palfijn Hospital Gent, Ghent, Belgium
| | - Marie-Line M van der Poorten
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Chris H Bridts
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Mark Walschot
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Jean-Pierre Timmermans
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology, AZ Jan Palfijn Hospital Gent, Ghent, Belgium.
| |
Collapse
|
3
|
Ebo DG, Bridts CH, Mertens CH, Sabato V. Principles, potential, and limitations of ex vivo basophil activation by flow cytometry in allergology: A narrative review. J Allergy Clin Immunol 2021; 147:1143-1153. [DOI: 10.1016/j.jaci.2020.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
|
4
|
Berger AE, Durrieu C, Dzviga C, Perrot JL, Lambert C. Human peripheral basophils extended phenotype shows a high expression of CD244 immuno-regulatory receptor. J Immunol Methods 2021; 492:112951. [PMID: 33493550 DOI: 10.1016/j.jim.2020.112951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Basophils play a major physio-pathological role in hypersensitivity related diseases. Basophils express high affinity Immunoglobulin (Ig) E receptors (FcεRI), IgG and complement regulatory. Basophils also have immunoregulatory activity through interaction with T cells. The aim of this study was to look for the expression of markers reflecting the activation status of peripheral Basophil in healthy donors. METHOD the study was performed on 29 healthy donors, 62% females with a mean age of 50.1 + 17.0 years. Basophils were identified on their expression of CD123 without HLA-DR and/or CD193 in two 8 colors panels including CD46, CD55, CD59, CD203c, CD32 (FcγRII), CD64 (FcγRIII), CD163, CD137L (4-1BBL), CD252 (OX40L), CD244 (2B4) and CD3 on whole blood. Basophil activation with anti IgE was performed on 14 donors. RESULTS AND DISCUSSION Our results confirmed the Basophil expression of CD123, CD193 and CD203 (the latter is strongly increased under stimulation). Complement regulatory proteins (CD46, CD55, CD59) were expressed at the same levels as on other leukocytes; CD46, CD59 expression being slightly increased under stimulation. CD32 and CD163 scavenger were slightly higher than on lympho and not influenced by activation. CD252 or CD137L were expressed at low levels and significantly induced by stimulation. Most of all, CD244 was highly expressed on Basophils as compared to any other leukocytes in fresh peripheral blood. CONCLUSIONS Our study shows that human resting Basophils express IgE and IgG Fc receptors and check point receptor CD244 that could potentially play a role in their previously reported immunoregulatory activity in sensitization and even in tumor immune escape.
Collapse
Affiliation(s)
- Anne-Emmanuelle Berger
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Coralie Durrieu
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Charles Dzviga
- Allergology unit, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Jean-Luc Perrot
- Dermatology department, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Claude Lambert
- Immunology laboratory, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France; Allergology unit, University Hospital Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France.
| |
Collapse
|
5
|
Ebo DG, Elst J, Houdt M, Pintelon I, Timmermans J, Horiuchi T, Faber MA, Hagendorens MM, Mertens CM, Sabato V. Flow cytometric basophil activation tests: Staining of exteriorized basophil granule matrix by fluorescent avidin versus appearance of CD63. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:483-490. [DOI: 10.1002/cyto.b.21868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Didier G. Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Department of Immunology and Allergology AZ Jan Palfijn Gent, Ghent Belgium
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Michel Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology Department of Veterinary Sciences, University of Antwerp Antwerp Belgium
| | - Jean‐Pierre Timmermans
- Laboratory of Cell Biology and Histology Department of Veterinary Sciences, University of Antwerp Antwerp Belgium
| | - Tatsuo Horiuchi
- Department of Anesthesiology Gunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Margaretha A. Faber
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Margo M. Hagendorens
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Department of Pediatrics University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Christel M. Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla‐Med Research Consortium of Excellence University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Department of Immunology and Allergology AZ Jan Palfijn Gent, Ghent Belgium
| |
Collapse
|
6
|
Bridts CH, Sabato V, Mertens C, Hagendorens MM, De Clerck LS, Ebo DG. Flow Cytometric Allergy Diagnosis: Basophil Activation Techniques. Methods Mol Biol 2020; 2163:183-195. [PMID: 32766976 DOI: 10.1007/978-1-0716-0696-4_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The basis of flow cytometric allergy diagnosis is the quantification of changes in the expression of basophilic surface membrane markers (Ebo et al., Clin Exp Allergy 34: 332-339, 2004). Upon encountering specific allergens recognized by surface receptor FcεRI-bound IgE, basophils not only secrete and generate quantifiable bioactive mediators but also upregulate the expression of different markers (e.g., CD63, CD203c) which can be detected by multicolor flow cytometry using specific monoclonal antibodies (Ebo et al., Cytometry B Clin Cytom 74: 201-210, 2008). Here, we describe two flow cytometry-based protocols which allow the detection of surface marker activation (Method 1) and changes in intragranular histamine (Method 2), both reflecting different facets of basophil activation.
Collapse
Affiliation(s)
- Chris H Bridts
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Luc S De Clerck
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium.
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium.
| |
Collapse
|
7
|
Ebo DG, Elst J, Van Gasse A, De Puysseleyr L, Faber MA, Hagendorens MM, Mayorga L, Mertens C, Bridts CH, De Clerck LS, Sabato V. Basophil Activation Experiments in Immediate Drug Hypersensitivity: More Than a Diagnostic Aid. Methods Mol Biol 2020; 2163:197-211. [PMID: 32766977 DOI: 10.1007/978-1-0716-0696-4_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Correct diagnosis of immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge, mainly because of the absence of reliable in vitro tests, uncertainties associated with skin testing, and incomplete understanding of the underlying mechanisms. AIM To summarize and hypothesize on the potential of basophil activation test (BAT) as a safe aid to explore the mechanistic endotypes of IDHR, to identify antibody recognition sites, and to monitor drug desensitization. METHODS A literature search was conducted using the keywords "allergy, basophil activation, CD63, CD203c, diagnosis, drugs, hypersensitivity, flow cytometry"; this was complemented by the authors' own expertise. RESULTS At present BAT has mainly been employed as a diagnostic aid. However, evidence is emerging that the technique might also deepen our insights in immune (allergic) and nonimmune (nonallergic) mechanistic processes of IDHR. It is anticipated that BAT might also benefit the identification of antibody recognition sites and benefit our understandings of desensitization strategies. CONCLUSION Although the nondiagnostic application of BAT in IDHR is still in its infancy, with increasing employment, we can expect the technique to become a valuable asset to study many domains of IDHR that remain poorly understood.
Collapse
Affiliation(s)
- Didier G Ebo
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium.
- Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium.
| | - Jessy Elst
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Athina Van Gasse
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Leander De Puysseleyr
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Margaretha A Faber
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Lina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Allergy Unit, Hospital Regional Universitario de Málaga, ARADyAL, Malaga, Spain
| | - Christel Mertens
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Chris H Bridts
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Luc S De Clerck
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
- Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| |
Collapse
|
8
|
Saretta F, Mori F, Cardinale F, Liotti L, Franceschini F, Crisafulli G, Caimmi S, Bottau P, Bernardini R, Caffarelli C. Pediatric drug hypersensitivity: which diagnostic tests? ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:94-107. [PMID: 30830067 PMCID: PMC6502170 DOI: 10.23750/abm.v90i3-s.8171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
Along with the anamnesis and clinical evaluation, diagnostic tests are one of the mainstream key points in the evaluation and management of drug hypersensitivity reactions (DHR). A wide knowledge gap, both in diagnosis and management of pediatric DHR, must be filled. Only a few published studies evaluated sensitivity and specificity of skin and in vitro tests in children. However, selected case series show that diagnostic work-up for adults could be useful, with some limitations, in pediatric age. Indeed, despite improvement in in vivo and in vitro diagnosis, drug provocation test remains the gold standard in pediatric age, too. Unmet needs in children include multi-centric studies on incidence of DHR, utility and feasibility of in vivo and in vitro diagnostic tests and specifically dedicated guidelines for the diagnosis and management of DHR in children.
Collapse
Affiliation(s)
- Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy; Pediatric Allergy Unit, Department of Medicine, Udine, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Sabogal-Cuadro P, Zakzuk J. Prueba de activación de basófilos: aspectos técnicos, metodológicos y su utilidad clínica. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.61820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La prueba de activación de basófilos (PAB) se considera una técnica confiable y segura para el diagnóstico de problemas alérgicos.Objetivo. Profundizar en el estado del arte de la PAB y su utilidad clínica.Materiales y métodos. Se realizó una revisión narrativa de la literatura mediante la búsqueda electrónica en las bases de datos y metabuscadores Ovid Medline, Google Scholar y PubMed, sin limitar la búsqueda por fecha, idioma o tipo de artículo. Se buscaron artículos sobre los detalles técnicos de la PAB y su utilidad clínica en el manejo de las enfermedades alérgicas.Resultados. De los marcadores de activación, CD63 ha sido el más estudiado y es el que mejor representa un evento de degranulación anafiláctica, mientras que CD203c es representativo de varias formas de degranulación. La superioridad de uno sobre otro como prueba diagnóstica depende del problema alérgico estudiado. En cuanto a los métodos de detección de basófilos, su selección con un único marcador, CCR3, se propone como una opción con buena relación de costo-efectividad.Conclusiones. La PAB es una herramienta prometedora para evaluar en clínica las reacciones alérgicas de forma segura. Es necesario una mayor estandarización de protocolos para obtener resultados más reproducibles.
Collapse
|
11
|
Abstract
Background For most physicians, quantification of drug-specific immunoglobulin E (drug-sIgE) antibodies constitutes the primary in vitro measure to document immediate drug hypersensitivity reactions (IDHR). Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHR and impossible for non-IgE-mediated IDHR that result from alternative routes of basophil and mast cell activation. In these difficult cases, diagnosis might benefit from cellular tests such as basophil activation tests (BAT). Aim The aim was to review the potential and limitations of quantification of sIgE and BAT in diagnosing IDHR. The utility of quantification of serum tryptase is discussed. Methods A literature search was conducted using the key words allergy, basophil activation, CD63, CD203c, diagnosis, drugs, hypersensitivity, flow cytometry, specific IgE antibodies; this was complemented by the authors’ own experience. Results The drugs that have been most studied with both techniques are β-lactam antibiotics and curarizing neuromuscular blocking agents (NMBA). For sIgE morphine, data are available on the value of this test as a biomarker for sensitization to substituted ammonium structures that constitute the major epitope of NMBA, especially rocuronium and suxamethonium. For the BAT, there are also data on non-steroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. For β-lactam antibiotics, sensitivity and specificity of sIgE varies between 0 and 85% and 52 and 100%, respectively. For NMBA, sensitivity and specificity varies between 38.5 and 92% and 85.7 and 100%, respectively. Specific IgE to morphine should not be used in isolation to diagnose IDHR to NMBA nor opiates. For the BAT, sensitivity generally varies between 50 and 60%, whereas specificity attains 80%, except for quinolones and NSAIDs. Conclusions Although drug-sIgE assays and BAT can provide useful information in the diagnosis of IDHR, their predictive value is not absolute. Large-scale collaborative studies are mandatory to harmonize and optimize test protocols and to establish drug-specific decision thresholds.
Collapse
|
12
|
Cop N, Ebo DG, Bridts CH, Elst J, Hagendorens MM, Mertens C, Faber MA, De Clerck LS, Sabato V. Influence of IL-6, IL-33, and TNF-α on human mast cell activation: Lessons from single cell analysis by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:405-411. [PMID: 28802100 DOI: 10.1002/cyto.b.21547] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mechanisms that govern priming and degranulation of human mast cells (MCs) remain elusive. Besides, most of our knowledge is based on experiments from which data only reflect an average of all stimulated cells. This study aims at investigating the effects of proinflammatory cytokines IL-6, IL-33, and TNF-α on IgE-dependent and IgE-independent activation of individual MCs. METHODS MCs were derived from CD34+ progenitors isolated from 50 mL whole blood from 4 healthy controls and 5 birch pollen allergic patients. Passively sensitized MCs were preincubated with IL-6, IL-33, or TNF-α and stimulated with anti-IgE/birch pollen allergen or substance P, the latter being a ligand for the G-protein-coupled MRGPRX2-receptor. Activation-i.e., upregulation of CD203c-and anaphylactic degranulation-i.e., appearance of CD63-were measured using flow cytometry. RESULTS Preincubation with IL-33 demonstrated upregulated CD203c density without degranulation. Subsequent IgE-dependent stimulation (anti-IgE/birch pollen allergen) resulted in higher appearance of CD63 as compared to cells without preincubation, indicating IL-33 to exert a priming effect (P = 0.04). IL-6 only increased allergen-specific responses but to a lesser extent than IL-33. Combination of IL-33/IL-6 had a synergistic effect, demonstrating more degranulation in response to allergen. TNF-α had no effect on IgE-mediated activation, nor synergistic effects with IL-33. Stimulation with substance P resulted in degranulation that could not be enhanced by preincubation. CONCLUSIONS In conclusion, IL-33, and in a lesser extent IL-6, prime individual MCs for subsequent IgE-mediated activation. Moreover, this priming effect is synergistic. In contrast, none of the cytokines had a priming effect on MRGPRX2-mediated activation of MCs. © 2017 International Clinical Cytometry Society.
Collapse
Affiliation(s)
- Nathalie Cop
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Didier G Ebo
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Chris H Bridts
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Jessy Elst
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Margo M Hagendorens
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Science, University of Antwerp, Antwerp 2610, Belgium
| | - Christel Mertens
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Margaretha A Faber
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Luc S De Clerck
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| | - Vito Sabato
- Department of Immunology - Allergology - Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp 2610, Belgium
| |
Collapse
|
13
|
Lavergne SN. In Vitro Research Tools in the Field of Human Immediate Drug Hypersensitivity and Their Present Use in Small Animal Veterinary Medicine. Vet Sci 2016; 4:E1. [PMID: 29056660 PMCID: PMC5606612 DOI: 10.3390/vetsci4010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 12/18/2022] Open
Abstract
Drug hypersensitivity reactions (DHR) are immune-mediated idiosyncratic adverse drug events. Type I DHR are often referred to as "immediate" and involve B lymphocyte-secreted IgE that bind to the membrane of basophils and mast cells, inducing their degranulation. This review presents various in vitro tests that were developed in the field of human type I HS and implemented as clinical diagnostic tools in human cases of immediate DHR. The respective strengths and weaknesses of each test will be discussed in parallel of validation data such as specificity and sensitivity whenever available. Some of them have also been used as diagnostic tools in veterinary medicine, but not in cases of immediate DHR. Most of these diagnostic tools can be categorized into humoral and cellular tests. The former tests measure serum concentrations of factors, such as histamine, tryptase, and drug-specific IgE. The latter assays quantify markers of drug-induced basophil activation or drug-specific lymphocyte proliferation. Pharmacogenetic markers have also been investigated in immediate DHR, but not as extensively as in non-immediate ones. Throughout, practical aspects and limitations of the tests, as well as sensitivity and specificity parameters, will be presented. In addition, the experience of veterinary medicine with these diagnostic tools will be summarized. However, to date, none of them has ever been reported in a veterinary case of type I DHR.
Collapse
Affiliation(s)
- Sidonie N. Lavergne
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois-Urbana-Champaign, 2001 South Lincoln Av, Urbana, IL 61802, USA.
| |
Collapse
|
14
|
Cop N, Decuyper II, Faber MA, Sabato V, Bridts CH, Hagendorens MM, De Winter BY, De Clerck LS, Ebo DG. Phenotypic and functional characterization ofin vitrocultured human mast cells. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:348-354. [DOI: 10.1002/cyto.b.21399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/09/2016] [Accepted: 07/08/2016] [Indexed: 01/06/2023]
Affiliation(s)
- N Cop
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - II Decuyper
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - MA Faber
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - V Sabato
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - CH Bridts
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - MM Hagendorens
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
- Department of Pediatrics; Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Science, University of Antwerp; Antwerp 2610 Belgium
| | - BY De Winter
- Department of Pediatrics; Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Science, University of Antwerp; Antwerp 2610 Belgium
| | - LS De Clerck
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| | - DG Ebo
- Department of Immunology; Allergology, Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital; Antwerp 2610 Belgium
| |
Collapse
|
15
|
Mangodt EA, Van Gasse AL, Decuyper I, Uyttebroek A, Faber MA, Sabato V, Bridts CH, Hagendorens MM, Ebo DG. In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow. Int Arch Allergy Immunol 2015; 168:3-12. [PMID: 26524156 DOI: 10.1159/000440663] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs. METHODS A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise. RESULTS BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs. CONCLUSIONS The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
Collapse
Affiliation(s)
- Evelyne A Mangodt
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Lambert C. Testing Basophil reactivity in monitoring allergen specific immunotherapy: comments on Chirumbolo's paper. Hum Vaccin Immunother 2015; 10:3722-3. [PMID: 25668675 DOI: 10.4161/21645515.2014.979696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Claude Lambert
- a Immunology Laboratory; Pole de Biologie-Pathologie ; University Hospital ; Saint-Etienne , France
| |
Collapse
|
17
|
Cop N, Uyttebroek AP, Sabato V, Bridts CH, De Clerck LS, Ebo DG. Flow cytometric analysis of drug-Induced basophil histamine release. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:285-8. [DOI: 10.1002/cyto.b.21226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/16/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
Affiliation(s)
- N. Cop
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - A. P. Uyttebroek
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - V. Sabato
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - C. H. Bridts
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - L. S. De Clerck
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| | - D. G. Ebo
- Department of Immunology; Allergology; Rheumatology; Faculty of Medicine and Health Science; University of Antwerp, Antwerp University Hospital; Antwerpen 2610 Belgium
| |
Collapse
|
18
|
Witting Christensen SK, Kortekaas Krohn I, Thuraiaiyah J, Skjold T, Schmid JM, Hoffmann HJH. Sequential allergen desensitization of basophils is non-specific and may involve p38 MAPK. Allergy 2014; 69:1343-9. [PMID: 25040734 DOI: 10.1111/all.12482] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sequential allergen desensitization provides temporary tolerance for allergic patients. We adapted a clinical protocol to desensitize human blood basophils ex vivo and investigated the mechanism and allergen specificity. METHODS We included 28 adult, grass allergic subjects. The optimal, activating allergen concentration was determined by measuring activated CD63(+) CD193(+) SS(Low) basophils in a basophil activation test with 8 log-dilutions of grass allergen. Basophils in whole blood were desensitized by incubation with twofold to 2.5-fold increasing allergen doses in 10 steps starting at 1 : 1000 of the optimal dose. Involvement of p38 mitogen-activated protein kinase (MAPK) was assessed after 3 min of allergen stimulation (n = 7). Allergen specificity was investigated by desensitizing cells from multi-allergic subjects with grass allergen and challenging with optimal doses of grass, birch, recombinant house dust mite (rDer p2) allergen or anti-IgE (n = 10). RESULTS Desensitization reduced the fraction of blood basophils responding to challenge with an optimal allergen dose from a median (IQR) 81.0% (66.3-88.8) to 35.4% (19.8-47.1, P < 0.0001). CD63 MFI expression was reduced from 68 248 (29 336-92 001) to 30 496 (14 046-46 179, P < 0.0001). Basophils from multi-allergic subjects were desensitized with grass allergen. Challenge with grass allergen resulted in 39.6% activation (15.8-58.3). An unrelated challenge (birch, rDer p2 or anti-IgE) resulted in 53.4% activation (30.8-66.8, P = 0.16 compared with grass). Desensitization reduced p38 MAPK phosphorylation from a median 48.1% (15.6-92.8) to 26.1% (7.4-71.2, P = 0.047) and correlated with decrease in CD63 upregulation (n = 7, r > 0.79, P < 0.05). CONCLUSION Desensitization attenuated basophil response rapidly and non-specifically at a stage before p38 MAPK phosphorylation.
Collapse
Affiliation(s)
| | - I. Kortekaas Krohn
- Department of Pulmonary Medicine and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - J. Thuraiaiyah
- Department of Pulmonary Medicine and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - T. Skjold
- Department of Pulmonary Medicine and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - J. M. Schmid
- Department of Pulmonary Medicine and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - H. J. H. Hoffmann
- Department of Pulmonary Medicine and Allergy; Aarhus University Hospital; Aarhus Denmark
| |
Collapse
|
19
|
Uyttebroek AP, Sabato V, Faber MA, Cop N, Bridts CH, Lapeere H, De Clerck LS, Ebo DG. Basophil activation tests: time for a reconsideration. Expert Rev Clin Immunol 2014; 10:1325-35. [DOI: 10.1586/1744666x.2014.959498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Uyttebroek AP, Sabato V, Bridts CH, Ebo DG. In vitro diagnosis of immediate IgE-mediated drug hypersensitivity: warnings and (unmet) needs. Immunol Allergy Clin North Am 2014; 34:681-9, x. [PMID: 25017685 DOI: 10.1016/j.iac.2014.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Immediate drug hypersensitivity reactions (DHR) constitute an important health condition, with serious consequences of inadequate diagnosis. In this article, some of the most important issues related to in vitro diagnosis of IgE-mediated allergies are discussed. In vitro diagnostics will benefit from expanded and novel insights and understandings in drug chemical reactivity, protein binding, biotransformation, degradation, identification of (cross-reactive) drug antigenic determinants, and deeper understanding of sensitization routes. Collective efforts should be undertaken to activate fundamental and clinical investigations.
Collapse
Affiliation(s)
- Astrid P Uyttebroek
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Chris H Bridts
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium.
| |
Collapse
|
21
|
Basophils and Skin Disorders. J Invest Dermatol 2014; 134:1202-1210. [DOI: 10.1038/jid.2014.16] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/30/2013] [Accepted: 12/09/2013] [Indexed: 02/08/2023]
|
22
|
Ebo DG, Hagendorens MM, Bridts CH, Stevens WJ. In vitrodiagnosis of IgE-mediated allergy: breakthroughs in the last decade. Expert Rev Clin Immunol 2014; 8:9-11. [DOI: 10.1586/eci.11.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Abstract
The basis of flow cytometric allergy diagnosis is quantification of changes in expression of basophilic surface membrane markers (Ebo et al., Clin Exp Allergy 34: 332-339, 2004). Upon encountering specific allergens recognized by surface receptor FcεRI-bound IgE, basophils not only secrete and generate quantifiable bioactive mediators but also up-regulate the expression of different markers (e.g., CD63, CD203c) which can be detected by multicolor flow cytometry using specific monoclonal antibodies (Ebo et al., Cytometry B Clin Cytom 74: 201-210, 2008). Here, we describe two flow cytometry-based protocols which allow detection of surface marker activation (Method 1) and changes in intragranular histamine (Method 2), both reflecting different facets of basophil activation.
Collapse
|
24
|
Basophil activation testing. J Allergy Clin Immunol 2013; 132:777-87. [PMID: 23958648 DOI: 10.1016/j.jaci.2013.06.038] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 01/03/2023]
Abstract
Both the treatment of patients with allergic diseases and the study of allergic disease mechanisms depend on a wide variety of assays that in various ways assess the presence and function of IgE antibody. The study of allergic diseases could benefit from the study of its 2 principle cellular participants, mast cells and basophils, but the basophil is more accessible than mast cells for ex vivo studies. Its functionality is tested by using 2 predominant methodologies: the secretion of mediators of allergic inflammation and the expression of proteins on the plasma membrane after stimulation. Each approach has benefits. There are also many operational details to consider regardless of which general approach is taken, and proper interpretation of the methods requires a good understanding of the reagents used and the receptors expressed on basophils and a detailed understanding of the factors regulating aggregation of cell-surface IgE.
Collapse
|
25
|
Vila L, Moreno A, Gamboa PM, Martínez-Aranguren R, Sanz ML. Decrease in antigen-specific CD63 basophil expression is associated with the development of tolerance to egg by SOTI in children. Pediatr Allergy Immunol 2013; 24:463-8. [PMID: 23682931 DOI: 10.1111/pai.12070] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the last decade, there have been an increasing number of studies on achieving tolerance to foods by specific oral tolerance induction (SOTI). Still, the underlying mechanism of SOTI is unknown. Our aim was to describe changes in CD63 expression on basophils following in vitro Ag-specific stimulation by basophil activation test (BAT), after SOTI with egg in a pediatric population. METHODS Ten children with persistent allergy to egg were included. Skin prick tests (SPTs) and open food challenges (OFCs) were performed before SOTI. Specific IgE determination and BAT with egg white (EW), ovomucoid (OM), and ovalbumin (OVA) were performed before and after 1 month of the buildup phase of SOTI. RESULTS Total tolerance to egg was achieved in 9 cases and partial in one. After SOTI, there was a significant decrease in mean specific IgE levels (p < 0.05). CD63 expression also decreased (p < 0.05) in all patients. CONCLUSION Decrease in Ag-specific basophil responsiveness is associated with the development of clinical tolerance by SOTI.
Collapse
Affiliation(s)
- Leticia Vila
- Department of Pediatrics, Hospital Teresa Herrera, La Coruña, Spain.
| | | | | | | | | |
Collapse
|
26
|
Abstract
The basophil activation test (BAT) is a flow-cytometry-based functional assay that assesses the degree of cell activation after exposure to a stimuli. Though no standardized technique currently exists, recent advances have improved the performance of this assay, including identification of new basophil-specific markers and comparisons of the expression of CD63 to CD203c during activation. The basophil activation test has also been validated for many IgE-mediated disease conditions, which have been extensively reviewed elsewhere. This review focuses on the most recent applications of this test to the diagnosis of allergy to drugs, foods, venoms, and pollens, and the evolving role of the BAT in monitoring immunotherapy.
Collapse
|
27
|
MacGlashan D. Marked differences in the signaling requirements for expression of CD203c and CD11b versus CD63 expression and histamine release in human basophils. Int Arch Allergy Immunol 2012; 159:243-52. [PMID: 22722613 DOI: 10.1159/000332150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 08/24/2011] [Indexed: 01/02/2023] Open
Abstract
Many techniques are being used to examine the status of circulating human basophils including the enhanced expression of a variety of cell surface proteins. There is accumulating evidence that there are at least two compartments containing these activation marker proteins but there are only some indications for the signaling requirements for each of the compartments. This study began with published reports by other investigators who potentially dissociated CD63 expression from anaphylactic degranulation with the p38 inhibitor, SB203580, a possible falsification of a previously proposed hypothesis regarding CD63 expression. To explore the signaling requirements for CD63, a variety of pharmacological agents were used to inhibit or enhance 4 endpoints of basophil activation. First, it was found that inhibition of both histamine release and CD63 expression with SB203580 was concordant. But it was also found that this agent had no effect on increased expression of CD203c and CD11b. Actin polymerization inhibitors caused marked enhancement of CD63 expression (concordant with their effects on degranulation) with no effect on expression of CD203c and CD11b. The third generation syk inhibitor, NVP-QAB205, showed a 5-fold lower potency for inhibiting expression of CD203c and CD11b than for CD63. Finally, while desensitization of CD11b and CD203c expression occurs, it is slower than desensitization of the CD63 response. Taken together, these various observations demonstrate a marked difference in the early signaling requirements for the CD11b/CD203c compartment and CD63 degranulation and provide support for the hypothesis that CD11b and CD203c reside in a similar compartment.
Collapse
Affiliation(s)
- Donald MacGlashan
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA. dmacglas @ jhmi.edu
| |
Collapse
|
28
|
Antibody repertoire complexity and effector cell biology determined by assays for IgE-mediated basophil and T-cell activation. J Immunol Methods 2012; 383:4-20. [PMID: 22683539 DOI: 10.1016/j.jim.2012.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 05/23/2012] [Accepted: 05/29/2012] [Indexed: 11/23/2022]
Abstract
Effector cell activation and T-cell activation, the latter mediated by facilitated antigen presentation, are immunological mechanisms that play crucial roles in the manifestation and maintenance of allergic disease. In addition to their relevance for the pathogenesis of allergy in-vivo, in-vitro assays based on these immunological mechanisms have been established and used for diagnostics, for monitoring the progression of disease and for the effect of specific immunotherapy as well as for basic research purposes. Here we review different parameters that affect effector cell activation and facilitated antigen uptake and presentation, including assay designs, readout parameters and critical experimental conditions. Central to the two immunological mechanisms is complex formation between allergen-specific IgE, allergen, and cell surface-anchored immunoglobulin receptor; the high affinity IgE-receptor FcεRI on basophils and mast cells, and the low affinity IgE-receptor FcεRII (CD23) on B-cells. Accordingly, the effect of IgE repertoire complexity and allergen diversity on effector cell and facilitated antigen presentation is discussed in detail.
Collapse
|
29
|
Chirumbolo S. Basophil Activation Test in Allergy: Time for an Update? Int Arch Allergy Immunol 2012; 158:99-114. [DOI: 10.1159/000331312] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022] Open
|
30
|
Ebo DG, Bridts CH, Mertens CH, Hagendorens MM, Stevens WJ, De Clerck LS. Analyzing histamine release by flow cytometry (HistaFlow): A novel instrument to study the degranulation patterns of basophils. J Immunol Methods 2012; 375:30-8. [DOI: 10.1016/j.jim.2011.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
|
31
|
Sabato V, Verweij MM, Bridts CH, Levi-Schaffer F, Gibbs BF, De Clerck LS, Schiavino D, Ebo DG. CD300a is expressed on human basophils and seems to inhibit IgE/FcεRI-dependent anaphylactic degranulation. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 82:132-8. [DOI: 10.1002/cyto.b.21003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/17/2011] [Accepted: 11/23/2011] [Indexed: 11/11/2022]
|
32
|
Verweij MM, Sabato V, Nullens S, Bridts CH, De Clerck LS, Stevens WJ, Ebo DG. STAT5 in human basophils: IL-3 is required for its FcεRI-mediated phosphorylation. CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 82:101-6. [DOI: 10.1002/cyto.b.20629] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/13/2011] [Accepted: 09/21/2011] [Indexed: 12/14/2022]
|
33
|
Chirumbolo S, Zanoni G, Ortolani R, Vella A. In vitro Biphasic Effect of Honey Bee Venom on Basophils from Screened Healthy Blood Donors. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2010; 3:58-61. [PMID: 21217927 PMCID: PMC3005321 DOI: 10.4168/aair.2011.3.1.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 09/24/2010] [Indexed: 11/25/2022]
Abstract
Apis mellifera L. bee venom is the most studied hymenoptera allergen, but many aspects of its action on human basophils remain unclear. Allergologists seek evidence of the effectiveness of bee venom immunotherapy as this approach is the chosen treatment for systemic allergic reactions. The effect of bee venom on human basophils in vitro has not been studied in detail for many reasons, including the paucity of basophils in peripheral blood, inter-individual basophil response variability, and the reliability and predictability of basophil activation tests. We conducted a brief preliminary survey of the effect of Apis bee venom on healthy asymptomatic (non-allergic) subjects. A dose of an aqueous commercial extract of Apis bee venom as high as 10 µg/mL activated resting basophils (CD63=+80-90%, CD203c=+30%), while it inhibited the expression of CD63 (-50%) following basophil stimulation by the soluble agonists formyl-Met-Leu-Phe or anti-IgE. The activation of resting basophils appeared to be dose-related. Only when basophils were activated with an IgE-mediated agonist, did bee venom extract exhibit a possible priming mechanism at the lowest doses used only via CD63, while it was ineffective via CD203c. Autocrine interleukin-3 may play a role in the observed biphasic behavior.
Collapse
|
34
|
Wu S, Jin L, Vence L, Radvanyi LG. Development and application of 'phosphoflow' as a tool for immunomonitoring. Expert Rev Vaccines 2010; 9:631-43. [PMID: 20518718 DOI: 10.1586/erv.10.59] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Flow cytometry has revolutionized our ability to monitor immune responses by allowing us to simultaneously track a variety of cell surface and intracellular markers in discrete cell subsets in a highly sensitive and reproducible manner. This is especially critical in this new era of vaccinology trying to tackle the growing problems of chronic viral infections and cancer that not only evade host immune responses, but can negatively manipulate vaccine-induced immune responses. Thus, understanding how lymphocyte signaling is altered under normal and pathological conditions has become more critical. Over the last decade, a new flow cytometry technology called 'phosphoflow' (also sometimes called 'phosflow'), is rapidly developing for tracking multiple intracellular signaling molecules in the immune system at a single-cell level. Antibodies and reagents for tracking both tyrosine-phosphorylated and serine/threonine-phosphorylated signaling intermediaries in key immune signaling pathways have been developed, and phosphoflow is now starting to be applied to a wide variety of both preclinical and clinical studies on lymphocyte responses, as well as the functioning of cancer cells and virally infected cells. Here, we review the development of phosphoflow technology, its modern applications in the field of immunomonitoring and its current limitations. We then provide a perspective on the future of phosphoflow and a vision of how it can be applied to emerging critical questions in human vaccinology and public health.
Collapse
Affiliation(s)
- Sheng Wu
- Department of Melanoma Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
35
|
Verweij MM, De Knop KJ, Bridts CH, De Clerck LS, Stevens WJ, Ebo DG. P38 mitogen-activated protein kinase signal transduction in the diagnosis and follow up of immunotherapy of wasp venom allergy. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:302-7. [DOI: 10.1002/cyto.b.20531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 04/12/2010] [Indexed: 11/09/2022]
|
36
|
Chirumbolo S, Conforti A, Ortolani R, Vella A, Marzotto M, Bellavite P. Stimulus-specific regulation of CD63 and CD203c membrane expression in human basophils by the flavonoid quercetin. Int Immunopharmacol 2009; 10:183-92. [PMID: 19887118 DOI: 10.1016/j.intimp.2009.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 10/16/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Flavonoids, such as quercetin, were reported to inhibit histamine release and cytokine production by basophils, but there is no evidence describing their action on membrane markers and intracellular biochemical pathways. OBJECTIVE The aim of the study was to examine the effect of several quercetin doses on an in vitro human basophil activation system that evaluates up-regulation of membrane markers in response to agonists. METHODS Leukocyte buffy coats from K(2)-EDTA anti-coagulated blood were treated with different concentrations of quercetin and triggered with anti-IgE ("allergy model") and with N-formyl-Met-Leu-Phe (fMLP) ("inflammation model"). Basophils were captured as CD123(bright)/HLA-DR(non-expressing) cells in a flow cytometry analysis and fluorescence values of CD63-FITC, CD203c-PE and CD123-PECy5 were used to produce dose response curves. RESULTS Quercetin at a dose of 10 microg/ml strongly inhibited CD63 and CD203c membrane up-regulation triggered by both agonists, but it neither affected cell viability nor changed the expression of the phenotypic marker CD123. The anti-IgE model appeared highly sensitive to the effect of quercetin: a dose as low as 0.01 microg/ml was able to significantly decrease CD63 and CD203c membrane expression. In the fMLP model the dose response was different: quercetin doses from 0.01 to 0.1 microg/ml significantly increased up-regulation of membrane markers, achieving the highest effect with CD63. CONCLUSION Very low doses of quercetin, within the pharmacological range, inhibit IgE-mediated membrane marker's up-regulation but prime the response to the chemotactic peptide fMLP; this stimulus specificity may have implications on the possible therapeutic action of the flavonoid in different pathologies.
Collapse
Affiliation(s)
- S Chirumbolo
- Department of Morphological and Biomedical Sciences-Sect. Clinical Chemistry, University of Verona-University Hospital GB Rossi piazzale AL Scuro 10 37134 Verona, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Hausmann OV, Gentinetta T, Bridts CH, Ebo DG. The basophil activation test in immediate-type drug allergy. Immunol Allergy Clin North Am 2009; 29:555-66. [PMID: 19563997 DOI: 10.1016/j.iac.2009.04.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of drug allergy involves first the recognition of sometimes unusual symptoms as drug allergy and, second, the identification of the eliciting drug. This is an often difficult task, as the clinical picture and underlying pathomechanisms are heterogeneous. In clinical routine, physicians frequently have to rely upon a suggestive history and eventual provocation tests, both having their specific limitations. For this reason both in vivo (skin tests) and in vitro tests are investigated intensively as tools to identify the disease-eliciting drug. One of the tests evaluated in drug allergy is the basophil activation test (BAT). Basophils with their high-affinity IgE receptors are easily accessible and therefore can be used as indicator cells for IgE-mediated reactions. Upon allergen challenge and cross-linking of membrane-bound IgE antibodies (via Fc-epsilon-RI) basophils up-regulate certain activation markers on their surface such as CD63 and CD203c, as well as intracellular markers (eg, phosphorylated p38MAPK). In BAT, these alterations can be detected rapidly on a single-cell basis by multicolor flow cytometry using specific monoclonal antibodies. Combining this technique with in vitro passive sensitization of donor basophils with patients' serum, one can prove the IgE dependence of a drug reaction. This article summarizes the authors' current experience with the BAT in the diagnostic management of immediate-type drug allergy mediated by drug-specific IgE antibodies.
Collapse
Affiliation(s)
- Oliver V Hausmann
- Department of Allergology, Department of Rheumatology, Allergology and Clinical Immunology, Inselspital, Freiburgstrasse, University of Bern, Bern 3010, Switzerland.
| | | | | | | |
Collapse
|
38
|
|
39
|
Baeck M, Marot L, Nicolas JF, Pilette C, Tennstedt D, Goossens A. Allergic hypersensitivity to topical and systemic corticosteroids: a review. Allergy 2009; 64:978-94. [PMID: 19416135 DOI: 10.1111/j.1398-9995.2009.02038.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Corticosteroids, which are potent anti-inflammatory and immunomodulator agents used in the treatment of various inflammatory diseases including allergic diseases, can in some cases produce immediate or delayed hypersensitivity reactions. This review summarizes the epidemiological and clinical characteristics of such reactions, including related diagnostic issues. It also presents a detailed analysis of the proposed immunological mechanisms including underlying cross-reactions.
Collapse
Affiliation(s)
- M Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
40
|
Ebo DG, Hagendorens MM, Bridts CH, De Clerck LS, Stevens WJ. The basophil activation test in immediate drug allergy. Acta Clin Belg 2009; 64:129-35. [PMID: 19432025 DOI: 10.1179/acb.2009.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Diagnosis of drug allergy is not always straight forward for several reasons. First, a broad spectrum of drugs can elicit various immune-mediated diseases with distinct pathomechanism, secondly, although exact epitope identification is not mandatory for clinical diagnosis, the epitope that causes the reaction is frequently unknown, thirdly in vitro or in vivo test results might not be predictive of a clinical situation, and finally the gold standard or reference test for diagnosis, the drug challenge, is a complicated and sometimes dangerous endeavour. Upon challenge with specific allergens that cross-link membrane-bound IgE antibodies, basophils upregulate the expression of different activation markers such as CD63 and CD203c. These immunophenotypic alterations can be detected on a single-cell basis by multicolour flow cytometry using specific monoclonal antibodies in the basophil activation test (BAT). This review intends to summarise our current experience with the BAT in the diagnostic management of immediate-type allergy to drugs and related compounds that are generally (but not always) mediated by drug-specific IgE antibodies.
Collapse
Affiliation(s)
- D G Ebo
- Department of Immunology, Allergology and Rheumatology, University Hospital Antwerp, University Antwerp, Belgium
| | | | | | | | | |
Collapse
|
41
|
Aerts NE, Dombrecht EJ, Bridts CH, Hagendorens MM, de Clerck LS, Stevens WJ, Ebo DG. Simultaneous flow cytometric detection of basophil activation marker CD63 and intracellular phosphorylated p38 mitogen-activated protein kinase in birch pollen allergy. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:8-17. [DOI: 10.1002/cyto.b.20437] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/14/2008] [Accepted: 05/30/2008] [Indexed: 11/06/2022]
|
42
|
Moloney M, Shreffler WG. Basic science for the practicing physician: flow cytometry and cell sorting. Ann Allergy Asthma Immunol 2008; 101:544-9. [PMID: 19055210 DOI: 10.1016/s1081-1206(10)60295-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marla Moloney
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, New York 10029, USA
| | | |
Collapse
|
43
|
Williams P, Sewell WAC, Bunn C, Pumphrey R, Read G, Jolles S. Clinical immunology review series: an approach to the use of the immunology laboratory in the diagnosis of clinical allergy. Clin Exp Immunol 2008; 153:10-8. [PMID: 18577028 DOI: 10.1111/j.1365-2249.2008.03695.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In the last 10 years UK immunology laboratories have seen a dramatic increase in the number and range of allergy tests performed. The reasons for this have been an increase in the incidence of immunoglobulin E (IgE)-mediated allergic disease set against a background of greater public awareness and more referrals for assessment. Laboratory testing forms an integral part of a comprehensive allergy service and physicians treating patients with allergic disease need to have an up-to-date knowledge of the range of tests available, their performance parameters and interpretation as well as the accreditation status of the laboratory to which tests are being sent. The aim of this review is to describe the role of the immunology laboratory in the assessment of patients with IgE-mediated allergic disease and provide an up-to-date summary of the tests currently available, their sensitivity, specificity, interpretation and areas of future development.
Collapse
Affiliation(s)
- P Williams
- Department of Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK.
| | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- D G Ebo
- Department of Immunology-Allergology-Rheumatology, University of Antwerp, Campus Drie Eiken T401, Universiteitsplein 1, B 2610 Antwerpen, Belgium
| | | | | | | |
Collapse
|
45
|
Ebo DG, Bridts CH, Hagendorens MM, Aerts NE, De Clerck LS, Stevens WJ. Basophil activation test by flow cytometry: Present and future applications in allergology. CYTOMETRY PART B-CLINICAL CYTOMETRY 2008; 74:201-10. [DOI: 10.1002/cyto.b.20419] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|