@article{3fd5e3491bf04b53a69925f73e410e4b,
title = "Basophil activation test as predictor of severity and threshold of allergic reactions to egg",
abstract = "Background: Identifying patients at risk of severe allergic reactions and/or low threshold of reactivity is very important, particularly for staple foods like egg. Methods: One hundred and fifty children underwent double-blind placebo-controlled food challenge (DBPCFC) to baked egg (BE), skin prick testing and blood collection for serology and basophil activation test (BAT). Patients who passed BE DBPCFC underwent loosely cooked egg (LCE) DBPCFC. Severity of allergic reactions was classified following Practall guidelines and threshold dose was determined during DBPCFC. Results: Sixty out of 150 (40%) children reacted to BE and 16 out of 77 (21%) to LCE on DBPCFC. Considering DBPCFC to BE, 23 children (38%) had severe reactions and 33 (55%) reacted to 0.13 g or less of egg protein (low threshold group). Two children (2 out of 16 = 12%) had severe reactions to LCE. Demographic, clinical and most immunological features were not significantly different between severe/non-severe BE reactors or low/high threshold groups. Severe BE reactors had higher ovomucoid-sIgE (p =.009) and higher BAT to BE (p =.001). Patients with lower threshold to BE had higher IgE-specific activity (p =.027) and BAT to egg (p =.007) but lower severity score (p =.008). Optimal cut-offs for ovomucoid-sIgE had 100% sensitivity, 35% specificity and 60% accuracy and for BAT 76% sensitivity, 74% specificity and 75% accuracy to identify BE severe reactors. Optimal cut-offs for specific activity had 70% sensitivity, 68% specificity and 69% accuracy and for BAT 70% sensitivity, 72% specificity and 71% accuracy to identify low threshold patients. Conclusions: BAT was the best biomarker to predict severity and threshold of allergic reactions to BE and can be useful when making decisions about management of egg allergy.",
keywords = "baked egg allergy, basophil activation test, egg allergy, severity, threshold",
author = "Suzana Radulovic and Foong, {Ru Xin} and Irene Bartha and Andreina Marques-Mejias and Marta Krawiec and Matthew Kwok and Zainab Jama and Faye Harrison and Cristian Ricci and Gideon Lack and George Du Toit and Santos, {Alexandra F.}",
note = "Funding Information: The authors would like to thank the Seal Clinical Research Facility Team, especially Helen Willis, Harriet Woodhead and other research nurses for help with study visits; Yasmin Abdat, Isabelle Olson and Georgia Hill for study coordination; Ewa Pietraszewicz and Joanna Craven for support with data management; Charlotte Stedman for help with food challenges and other dietary aspects. Acknowledgements are due as well to the Children's Allergy clinical team of Evelina London Children's Hospital for referring patients to the study and for clinical assistance. The authors are also grateful to Lucia Jimeno‐Nogales from ALK‐Abello for providing allergen extracts for SPT and BAT; Thermofisher Scientific for providing some of the reagents for specific IgE and IgG4 testing; Sanovo Technology Group for providing the egg powder used in the baked egg challenges; and the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust, for supporting the Flow Core Facility. Funding Information: This study was funded by the Medical Research Council through MRC Clinician Scientist Fellowship MR/M008517/1 and MRC Transition Fellowship MR/T032081/1 awarded to A. F. Santos. Funding Information: Dr Radulovic reports salary support from grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH). Dr Lack reports grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH), other from Food Allergy & Research Education (FARE), other from MRC & Asthma UK Centre, other from UK Dept of Health through NIHR, other from National Peanut Board (NPB), other from The Davis Foundation, during the conduct of the study; shareholder in DBV Technologies, and Mighty Mission Me, personal fees from Novartis, personal fees from Sanofi‐Genyzme, personal fees from Regeneron, personal fees from ALK‐Abello, personal fees from Lurie Children's Hospital, outside the submitted work. Dr Du Toit reports grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH), Food Allergy & Research Education (FARE), MRC & Asthma UK Centre, UK Dept of Health through NIHR, Action Medical Research and National Peanut Board. Scientific Advisory Board member Aimmune. Investigator on pharma‐sponsored allergy studies (Aimmune, and DBV Technologies). Scientific advisor to Aimmune, DBV and Novartis. Dr Santos reports grants from Medical Research Council (MR/M008517/1; MC/PC/18052; MR/T032081/1), Food Allergy Research and Education (FARE), the Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (NIAID, NIH), Asthma UK (AUK‐BC‐2015‐01), BBSRC, Rosetrees Trust and the NIHR through the Biomedical Research Centre (BRC) award to Guy's and St Thomas' NHS Foundation Trust, during the conduct of the study; personal fees from Thermo Scientific, Nutricia, Infomed, Novartis, Allergy Therapeutics, Buhlmann, as well as research support from Buhlmann and Thermo Fisher Scientific through a collaboration agreement with King's College London. The other authors have nothing to disclose. Publisher Copyright: {\textcopyright} 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.",
year = "2023",
month = sep,
day = "8",
doi = "10.1111/all.15875",
language = "English",
journal = "Allergy: European Journal of Allergy and Clinical Immunology",
issn = "0105-4538",
publisher = "John Wiley and sons",
}