Benefit of the basophil activation test in deciding when to reintroduce cow's milk in allergic children

• Published in: Allergy (Copenhagen) 2011, Vol.66 (1), p.92-100
• Main Authors: Rubio, A, Vivinus-Nébot, M, Bourrier, T, Saggio, B, Albertini, M, Bernard, A
• Format: Article
• Language: English
• Subjects: Allergic diseases; Animals; basophil activation test; Basophil Degranulation Test - methods; Basophils - immunology; Biological and medical sciences; Child; Child, Preschool; children; Children & youth; cow’s milk allergy; Dermatology; Diagnostic tests; Digestive allergic diseases; Female; Flow Cytometry; Food allergies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hypersensitivity, Immediate - diagnosis; Hypersensitivity, Immediate - immunology; Immunoglobulin E - blood; Immunopathology; Infant; Male; Medical sciences; Milk; Milk - adverse effects; Milk - immunology; Milk Hypersensitivity - diagnosis; Milk Hypersensitivity - immunology; oral challenge test; Predictive Value of Tests; ROC Curve; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; Skin Tests
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/j.1398-9995.2010.02432.x

To cite this article: Rubio A, Vivinus-Nébot M, Bourrier T, Saggio B, Albertini M, Bernard A. Benefit of the basophil activation test in deciding when to reintroduce cow's milk in allergic children. Allergy 2011; 66: 92-100. ABSTRACT: Background: Oral challenges are required to establish the persistence or resolution of IgE-mediated cow's milk allergy (CMA). Determining the appropriate timing for challenging is the main difficulty. The benefit of the basophil activation test (BAT) in predicting a child's reaction to the oral challenge was evaluated and compared to the specific IgE and skin prick tests' (SPT) results. Methods: One hundred and twelve consecutive children with CMA admitted for an oral challenge to reassess their allergy were included. Allergen-induced basophil activation was detected as a CD63-upregulation by flow cytometry. Results: Thirty-six children (32%) had a positive oral challenge. The percentage of activated basophils in patients with a positive challenge (mean = 20.9; SD = 18.8) was significantly higher than that of patients with a negative challenge (mean = 3.9; SD = 9.8, P < 0.0001), and was well correlated with the eliciting dose of cow's milk (P < 0.0001). The BAT had an efficiency of 90%, a sensitivity of 91%, a specificity of 90%, and positive and negative predictive values of 81% and 96% in detecting persistently allergic patients. The area under the ROC curve was 0.866. These scores were higher than those obtained with SPT and IgE values, whichever positivity cut-point was chosen. Referring to a decisional algorithm combining BAT, specific IgE and SPT allowed the correct identification of 94% of patients as tolerant or persistently allergic to cow's milk proteins (CMP) in our cohort. Conclusion: The BAT could be a valuable tool in the management of paediatric CMA in addition to specific IgE quantification and SPT, by contributing in determining whether an oral challenge can safely be undertaken.