BUHLMANN Flow CAST® Basophil Activation Testing (BAT) in Children
Food allergy is one of the leading causes of potentially life-threatening anaphylactic reactions and a public health concern in Canada, especially among children. Over 3 million Canadians are affected by food allergy, of which approximately 600,000 are children. The impact of food allergy is far greater, with an estimated 50% of households being either directly or indirectly affected by food allergy. That means 1-in-2 Canadian households are impacted by food allergy.
Accurately diagnosing a possible food allergy is important to avoid unnecessary dietary restrictions and to prevent life threatening reactions. An initial assessment of immediate type allergic reactions relies upon clinical history and diagnostic testing, such as quantification of specific IgE (sIgE) antibodies and skin prick tests (SPT). However, these techniques are not sufficient to diagnose food allergy on their own as they are not predictive of reaction severity. Currently, if the SPT and sIgE are equivocal, an oral food challenge (OFC) is frequently used to clarify the presence of an immediate type allergic disorder.
For children undergoing an OFC, there is an additional element of emotional stress as the reaction rate associated with OFC, including lower respiratory and or laryngeal symptoms has been reported as high in as many as 28% of patients. Along with the inherent risk associated with OFCs, testing can be labor intensive and can be costly given the time and trained medical staff required for the procedure.
Clinical interest in basophil activation testing (BAT) has grown given its ability to simulate an allergic reaction ex-vivo, mitigating the patient risk and costs associated with OFC testing. BAT is a functional assay that measure the degree of degranulation following stimulation with allergens. The degree of degranulation correlates directly with histamine release.
Inter Medico’s partner BUHLMANN Laboratories supports allergy diagnostics with their Flow CAST® test for the qualitative assessment of basophil activation upon stimulation with specific allergens. It is intended as an aid to diagnosis of immediate type allergic disorders in conjunction with other clinical and laboratory findings.
A potential value of the BUHLMANN Flow CAST® BAT test could be to run as a secondary line diagnostic in children who have a positive sIgE and/or SPT test. Given the high specificity of BAT, a positive result may be sufficient to confirm the immediate allergy, avoiding the need for an OFC test. A negative BAT result cannot exclude an allergy; therefore, an OFC test would still be needed.
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