Basophil activation test reduces oral food challenges to nuts and sesame

TY - JOUR

T1 - Basophil activation test reduces oral food challenges to nuts and sesame

AU - Santos, Alexandra F

AU - Bergmann, Marcel

AU - Brough, Helen A

AU - Couto-Francisco, Natália

AU - Kwok, Matthew

AU - Panetta, Valentina

AU - Haddad, Diab

AU - Lack, Gideon

AU - Eigenmann, Philippe

AU - Caubet, Jean-Christoph

N1 - Copyright © 2020. Published by Elsevier Inc.

PY - 2020

Y1 - 2020

N2 - BACKGROUND: Nut allergic patients are often IgE sensitized to other nuts/seeds and need multiple oral food challenges (OFC) before the safe nuts can be introduced in the diet. However, OFC are time-consuming and risky procedures.OBJECTIVE: to assess the utility of the basophil activation test (BAT) to predict the allergic status and reduce the need for OFC in children with one or more nut or seed allergies.METHODS: Participants in the Pronuts study recruited at the Geneva and the London centers were tested on the BAT to hazelnut, cashew nut, sesame, almond and peanut, Ara h 1, Ara h 2, Ara h 6, using FlowCAST, a commercially available BAT kit, and flow cytometry.RESULTS: The BAT to hazelnut, cashew nut, sesame, almond and peanut discriminated between allergic and non-allergic children, to the respective nut or seed. The optimal allergen concentration and their optimal, positive and negative cut-offs were identified for BAT and the other tests, for each nut and seed. Using BAT as a second step in the diagnostic process, following equivocal skin prick test and IgE to extracts and components, reduced the number of total OFCs by 5-15% and of positive OFC by 33-75% (except for hazelnut) with 0% false-negatives and a diagnostic accuracy of 96-100%.CONCLUSION: The BAT proved to be a useful diagnostic tool, used in a stepwise approach, to predict the allergic status and reduce the number of OFC in the Pronuts study patients with at least one nut allergy willing to consume selected nuts.

AB - BACKGROUND: Nut allergic patients are often IgE sensitized to other nuts/seeds and need multiple oral food challenges (OFC) before the safe nuts can be introduced in the diet. However, OFC are time-consuming and risky procedures.OBJECTIVE: to assess the utility of the basophil activation test (BAT) to predict the allergic status and reduce the need for OFC in children with one or more nut or seed allergies.METHODS: Participants in the Pronuts study recruited at the Geneva and the London centers were tested on the BAT to hazelnut, cashew nut, sesame, almond and peanut, Ara h 1, Ara h 2, Ara h 6, using FlowCAST, a commercially available BAT kit, and flow cytometry.RESULTS: The BAT to hazelnut, cashew nut, sesame, almond and peanut discriminated between allergic and non-allergic children, to the respective nut or seed. The optimal allergen concentration and their optimal, positive and negative cut-offs were identified for BAT and the other tests, for each nut and seed. Using BAT as a second step in the diagnostic process, following equivocal skin prick test and IgE to extracts and components, reduced the number of total OFCs by 5-15% and of positive OFC by 33-75% (except for hazelnut) with 0% false-negatives and a diagnostic accuracy of 96-100%.CONCLUSION: The BAT proved to be a useful diagnostic tool, used in a stepwise approach, to predict the allergic status and reduce the number of OFC in the Pronuts study patients with at least one nut allergy willing to consume selected nuts.

U2 - 10.1016/j.jaip.2020.12.039

DO - 10.1016/j.jaip.2020.12.039

M3 - Article

C2 - 33385591

SN - 2213-2198

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

ER -