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AL De Weck,1 ML Sanz,1
PM Gamboa,2 W Aberer,3 G Sturm,3
MB Bilo,4 M Montroni,4 M Blanca,5
MJ Torres,5 L Mayorga,5 P Campi,6
M Manfredi,6 M Drouet,7 J
Sainte-Laudy,8 A Romano,9 H Merk,10
JM Weber,11 TM Jermann,11 and
members of ENDA (European Network for Drug Allergy) |
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1 Department of Allergology and
Clinical Immunology, University of Navarra,
Collaborative Center of GA2LEN, Pamplona, Spain
2 Allergy Division, Hospital Basurto, Bilbao, Spain
3 Department of Dermatology, University of Graz, Graz,
Austria
4 University Hospital, Ancona, Italy
5 Hospital Haya, Malaga, Spain
6 University Hospital, Florence, Italy
7 Centre Hospitalier Universitaire, Angers, France
8 Centre Hospitalier Universitaire, Limoges, France
9 Allergy Unit, Complesso Integrato Columbus, Rome,
Italy
10 Dermatology Clinic, University Hospital, Aachen,
Germany
11 Bühlmann Laboratories AG, Allschwil, Switzerland |
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Abstract |
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Introduction:
This multicenter
study aimed to
evaluate the
diagnostic value of
2 cellular tests
based on basophil
reactivitythe
basophil activation
test (BAT,
Flow-CAST) and the
sulfi doleukotriene
release assay
(CAST-ELISA)in
immediate-type
ß-lactam allergy,
particularly in
patients with a
clinical history of
allergy and a
negative skin test
result.
Material and
Methods: In a
multicenter study
encompassing 10
European centers,
181 patients with a
history of
immediate-type
ß-lactam allergy,
and 81 controls, we
evaluated the
diagnostic effi
ciency of specifi c
IgE determinations
and of 2 cellular
tests based on
basophil reactivity,
the BAT and the
sulfi oleukotriene
release assay.
Results: With
Flow-CAST,
sensitivity varied
for individual
ß-lactam allergens
from 16% for
penicilloyl-polylysine
to 33% for
amoxicillin,
reaching 50% when
all 5 allergens were
considered. In
ß-lactamallergic
patients with
negative skin test
results (22.8%),
Flow-CAST showed
positive results for
at least 1 of the 5
allergens in 37%.
Specifi city varied
from 89% to 97%,
depending on the
allergens used. In
CAST-ELISA, the
overall sensitivity
in skin
testpositive
patients was 41.7%;
in patients with
negative skin test
results it was
27.9%. Both tests
were not absolutely
correlated, so that
when all the results
were considered
together,
sensitivity
increased to 64.3%
and specificity
varied for both
tests combined from
73% to 92%. In
contrast, specific
IgE determinations
in the same
population yielded a
lower sensitivity
(28.3%).
Conclusions:
A diagnostic
algorithm including
skin tests and
specifi c IgE,
followed by cellular
tests in negative
patients and
controlled
challenge enabled us
to confi rm ß-lactam
allergy in 92% of
cases. This
procedure would also
allow us to avoid
two-thirds of the
required
controlled
challenges.
Key words:
Immediate-type
ß-lactam allergy. In
vitro diagnosis.
Cellular tests. BAT.
Sulfidoleukotriene
production.
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