The basophil activation test differentiates between patients with alpha-gal syndrome and asymptomatic alpha-gal sensitization - 04/01/19
Abstract |
Background |
Galactose-alpha-1,3-galactose (alpha-gal) syndrome is characterized by the presence of serum specific IgE antibodies to alpha-gal and delayed type I allergic reactions to the carbohydrate alpha-gal after consumption of mammalian (red) meat products and drugs of mammalian origin. Diagnostics currently rely on patient history, skin tests, determination of serum specific IgE antibodies, and oral food or drug challenges.
Objective |
We sought to assess the utility of different basophil parameters (basophil reactivity and sensitivity, the ratio of the percentage of CD63+ basophils induced by the alpha-gal–containing allergen to the percentage of CD63+ basophils after stimulation with anti-FcεRI antibody [%CD63+/anti-FcεRI], and area under the dose-response curve [AUC]) as biomarkers for the clinical outcome of patients with alpha-gal syndrome compared with subjects with asymptomatic alpha-gal sensitization.
Methods |
In addition to routine diagnostics, a basophil activation test (Flow CAST) with different concentrations of alpha-gal–containing allergens (eg, commercially available alpha-gal–carrying proteins and pork kidney extracts) was performed in 21 patients with alpha-gal syndrome, 12 alpha-gal–sensitized subjects, and 18 control subjects.
Results |
Alpha-gal–containing allergens induced strong basophil activation in a dose-dependent manner in patients. Basophil reactivity at distinct allergen concentrations, the %CD63+/anti-FcεRI ratio across most allergen concentrations, the AUC of dose-response curves, and basophil allergen threshold sensitivity (CD-sens) with pork kidney extract were significantly higher in patients with alpha-gal syndrome compared with those in sensitized subjects. All parameters were negative in control subjects.
Conclusion |
The basophil activation test should be considered as an additional diagnostic test before performing time-consuming and potentially risky oral provocation tests. The %CD63+/anti-FcεRI ratio for all allergens and AUCs for pork kidney were the best parameters for distinguishing patients with alpha-gal syndrome from subjects with asymptomatic alpha-gal sensitization.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Basophil activation test, alpha-gal syndrome, galactose-alpha-1,3-galactose, red meat allergy, CD63, CCR3, basophil allergen threshold sensitivity (CD-sens), asymptomatic alpha-gal sensitization
Abbreviations used : AHSG, alpha-gal, AUC, BAT, %CD63+/anti-FcεRI, CD-sens, EC50, P patients, ROC, sIgE, SPT, SPPT, S subjects
Plan
| Supported in part by the Ministry of Higher Education and Research of Luxembourg. |
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| Disclosure of potential conflict of interest: J. Mehlich and B. Eberlein received methodological and technical support from the company BÜHLMANN Laboratories AG (Schönenbuch, Switzerland) and received travel support from ALK-Abelló outside the submitted work. M. Schiener received travel support from ALK-Abelló and Bencard outside the submitted work. S. Blank reports grants from Allergy Therapeutics and Bencard Allergie GmbH, is a member of the advisory board and has received personal fees from Bencard Allergie GmbH, has received personal fees from Thermo Fisher Scientific and Teomed AG, and has received travel support from ALK-Abelló outside the submitted work. M. Ollert gave advice to or received an honorarium for talks from the following companies: Siemens Healthcare, Hitachi Chemical Diagnostics, Hycor, Thermo Fisher Phadia, and Bencard outside the submitted work; he also is scientific cofounder of the biotech spinoff companies PLS-Design GmbH and Tolerogenics SarL, both outside the submitted work. U. Darsow gave advice to or received an honorarium for talks or research grant from the following companies: ALK-Abelló, Bencard, Meda, Novartis, and Sanofi-Regeneron outside the submitted work. T. Biedermann received nonfinancial support from BÜHLMANN Laboratories AG and gave advice to or got a honorarium for talks or research grant from the following companies: Alk-Abelló, Astellas, Bencard, Biogen, Celgene, Janssen, Leo, Meda, Mylan, MSD, Novartis, Phadia-Thermo Fisher, and Sanofi-Regeneron outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 143 - N° 1
P. 182-189 - janvier 2019 Retour au numéro
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