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Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut.
J Allergy Clin Immunol. 2015 Jan; 135(1):179-86.JA

Abstract

BACKGROUND

The management of peanut allergy relies on allergen avoidance and epinephrine autoinjector for rescue treatment in patients at risk of anaphylaxis. Biomarkers of severity and threshold of allergic reactions to peanut could significantly improve the care for patients with peanut allergy.

OBJECTIVE

We sought to assess the utility of the basophil activation test (BAT) to predict the severity and threshold of reactivity to peanut during oral food challenges (OFCs).

METHODS

The severity of the allergic reaction and the threshold dose during OFCs to peanut were determined. Skin prick tests, measurements of specific IgE to peanut and its components, and BATs to peanut were performed on the day of the challenge.

RESULTS

Of the 124 children submitted to OFCs to peanut, 52 (median age, 5 years) reacted with clinical symptoms that ranged from mild oral symptoms to anaphylaxis. Severe reactions occurred in 41% of cases, and 57% reacted to 0.1 g or less of peanut protein. The ratio of the percentage of CD63(+) basophils after stimulation with peanut and after stimulation with anti-IgE (CD63 peanut/anti-IgE) was independently associated with severity (P = .001), whereas the basophil allergen threshold sensitivity CD-sens (1/EC₅₀ × 100, where EC₅₀ is half maximal effective concentration) value was independently associated with the threshold (P = .020) of allergic reactions to peanut during OFCs. Patients with CD63 peanut/anti-IgE levels of 1.3 or greater had an increased risk of severe reactions (relative risk, 3.4; 95% CI, 1.8-6.2). Patients with a CD-sens value of 84 or greater had an increased risk of reacting to 0.1 g or less of peanut protein (relative risk, 1.9; 95% CI, 1.3-2.8).

CONCLUSIONS

Basophil reactivity is associated with severity and basophil sensitivity is associated with the threshold of allergic reactions to peanut. CD63 peanut/anti-IgE and CD-sens values can be used to estimate the severity and threshold of allergic reactions during OFCs.

Authors+Show Affiliations

Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal; Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal.Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.Department of Public Health Science, School of Medicine, King's College London, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom. Electronic address: gideon.lack@kcl.ac.uk.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25567046

Citation

Santos, Alexandra F., et al. "Distinct Parameters of the Basophil Activation Test Reflect the Severity and Threshold of Allergic Reactions to Peanut." The Journal of Allergy and Clinical Immunology, vol. 135, no. 1, 2015, pp. 179-86.
Santos AF, Du Toit G, Douiri A, et al. Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut. J Allergy Clin Immunol. 2015;135(1):179-86.
Santos, A. F., Du Toit, G., Douiri, A., Radulovic, S., Stephens, A., Turcanu, V., & Lack, G. (2015). Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut. The Journal of Allergy and Clinical Immunology, 135(1), 179-86. https://doi.org/10.1016/j.jaci.2014.09.001
Santos AF, et al. Distinct Parameters of the Basophil Activation Test Reflect the Severity and Threshold of Allergic Reactions to Peanut. J Allergy Clin Immunol. 2015;135(1):179-86. PubMed PMID: 25567046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut. AU - Santos,Alexandra F, AU - Du Toit,George, AU - Douiri,Abdel, AU - Radulovic,Suzana, AU - Stephens,Alick, AU - Turcanu,Victor, AU - Lack,Gideon, PY - 2014/07/29/received PY - 2014/08/27/revised PY - 2014/09/02/accepted PY - 2015/1/9/entrez PY - 2015/1/9/pubmed PY - 2015/3/3/medline KW - Basophil activation test KW - CD-sens KW - CD203c KW - CD63 KW - double-blind KW - peanut KW - peanut allergy KW - placebo-controlled food challenge KW - sensitivity KW - severity KW - threshold SP - 179 EP - 86 JF - The Journal of allergy and clinical immunology JO - J Allergy Clin Immunol VL - 135 IS - 1 N2 - BACKGROUND: The management of peanut allergy relies on allergen avoidance and epinephrine autoinjector for rescue treatment in patients at risk of anaphylaxis. Biomarkers of severity and threshold of allergic reactions to peanut could significantly improve the care for patients with peanut allergy. OBJECTIVE: We sought to assess the utility of the basophil activation test (BAT) to predict the severity and threshold of reactivity to peanut during oral food challenges (OFCs). METHODS: The severity of the allergic reaction and the threshold dose during OFCs to peanut were determined. Skin prick tests, measurements of specific IgE to peanut and its components, and BATs to peanut were performed on the day of the challenge. RESULTS: Of the 124 children submitted to OFCs to peanut, 52 (median age, 5 years) reacted with clinical symptoms that ranged from mild oral symptoms to anaphylaxis. Severe reactions occurred in 41% of cases, and 57% reacted to 0.1 g or less of peanut protein. The ratio of the percentage of CD63(+) basophils after stimulation with peanut and after stimulation with anti-IgE (CD63 peanut/anti-IgE) was independently associated with severity (P = .001), whereas the basophil allergen threshold sensitivity CD-sens (1/EC₅₀ × 100, where EC₅₀ is half maximal effective concentration) value was independently associated with the threshold (P = .020) of allergic reactions to peanut during OFCs. Patients with CD63 peanut/anti-IgE levels of 1.3 or greater had an increased risk of severe reactions (relative risk, 3.4; 95% CI, 1.8-6.2). Patients with a CD-sens value of 84 or greater had an increased risk of reacting to 0.1 g or less of peanut protein (relative risk, 1.9; 95% CI, 1.3-2.8). CONCLUSIONS: Basophil reactivity is associated with severity and basophil sensitivity is associated with the threshold of allergic reactions to peanut. CD63 peanut/anti-IgE and CD-sens values can be used to estimate the severity and threshold of allergic reactions during OFCs. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/25567046/Distinct_parameters_of_the_basophil_activation_test_reflect_the_severity_and_threshold_of_allergic_reactions_to_peanut_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(14)01266-4 DB - PRIME DP - Unbound Medicine ER -