The basophil activation test in the diagnosis and management of adverse drug reactions in the elderly

R. Cecere 1, R. Buquicchio 2, B. Girardi 3, R. Polimeno 4, G. Serviddio 1, P. Demoly 5 6, M.T. Ventura 7

1 Scuola di specializzazione in Geriatria, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; 5 Dermatological Clinic, Department of Biomedical Science and Human Oncology, Medical School, University of Bari “A. Moro”, Bari, Italy; 3 THD S.p.A., Correggio (RE), Italy; 4 Department of Interdisciplinary Medicine, Section of Sciences and Technologies of Laboratory Medicine, Medical School University of Bari “A. Moro”, Bari, Italy; 5 Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; 6 Equipe - EPAR – IPLESP UMRS 1136, UPMC Univ Paris 06, Sorbonne Universités, Paris, France; 7 Department of Interdisciplinary Medicine, Medical School University of Bari “A. Moro”, Bari, Italy

Background and aims. The use of multi-therapeutic regimes in the elderly predisposes to frequent adverse drug reactions. The objective of the present study was to evaluate the predictive value of the basophil activation test to prevent the risk of hypersensitivity reactions in the case of potentially dangerous drugs in the elderly.

Method. This study has been conducted in the Immuno-Allergy Unit of the Policlinico Hospital, in Bari. Patients over 65 years with hypersensitivity reactions were considered. The basophil activation Flow Cast test, performed following the manufacturer’s instructions, measured the degranulation of basophils, using the anti-CD63 and anti-CD203c monoclonal antibodies.

Results. 61 patients, suffering from urticaria-angioedema or anaphylaxis due to Beta-Lactam (BL) antibiotics (Group A: 28 females and 9 men; mean age 71.3) and non-steroidal anti-inflammatory drugs, NSAIDs (Group B: 20 females and 4 men; mean age 73.2), were included, as well as 2 control groups. Group C consisted of 17 women and 4 men tolerating BL and NSAIDs. Group D comprised 51 female and 19 male younger (mean age 39.7) patients with proven BL and/or NSAIDs hypersensitivity. Sensitivity and specificity were respectively 64.9% and 90.5% in group A with positive and negative predictive values equal to 92.3% and 59.4%, respectively. In the group B the respective figures were 54%, 80.9%, 6.5% and 60.7%.

Conclusions. Even though more evidences are needed to assess the suitability of the basophil activation test technique for the diagnosis of allergic reactions, this test gives promising results in the field of hypersensitivity to drugs in the elderly.

Download PDF