Allergy or not? New basophil activation test from Borstel improves routine diagnostics

A new test procedure improves allergy diagnostics: By optimizing the basophil activation test (BAT), a team of scientists at the Research Center Borstel creates an innovative method that measures allergies quickly and precisely. Unlike conventional methods, it can detect an actual allergic reaction, not just sensitization. The team led by Prof. Dr. Uta Jappe published the results in the journal Allergy in December and applied for a patent. Negotiations with an industry partner are underway to bring the method into routine diagnostics.

Allergies are among the most common chronic diseases in Europe. According to the German Robert Koch Institute, more than 20% of children, more than 35% of women and 24% of men develop at least one allergic disease. This might massively limit the quality of life. Reliable diagnostics and adequate treatment are therefore enormously important for those affected.

Standard diagnostics with weaknesses

Allergologists and dermatologists usually use skin prick tests and IgE antibody levels in the blood to investigate whether someone had contact with a particular allergen (e.g. birch pollen). While these methods are easy to use, they only show half the truth: they detect sensitization, i.e., a reaction of the immune system. However, they do not show whether this results in clinically relevant symptoms, i.e. a real allergy. In order to prove this in unclear cases, an additional provocation test with the allergen source is currently used. However, this test can cause considerable side effects in patients, including anaphylactic shock.

An alternative is the basophil activation test (BAT), which mimics the allergic reaction in vitro using blood samples. Basophils are blood cells that are activated as part of the allergic reaction. Until now, the test could not be used on a wider scale: Since the patients’ blood samples had to be processed immediately after collection, physicians without their own laboratories were unable to evaluate the BAT. In addition, there were no automated analysis procedures, which meant that the effort involved was disproportionately high. Last but not least, there was no standardized protocol for the BAT.

Optimized procedure could become routine

Uta Jappe’s research group has addressed all these problems together with Dr. Jochen Behrends’ team (Central Unit Fluorescence Cytometry). By optimizing the method, the Borstel scientists were able to establish a protocol that has the potential to replace expensive and risky provocation tests and to predict the severity of the allergic reaction. The methodology reduces personnel and material costs and uses a high-throughput fluorescence flow cytometer procedure. A validation already performed in a nationwide ring trial showed that the protocol is feasible regardless of instrument type and provides very accurate results. A patent application has been filed for the optimization of the BAT. “The possibility of using this safe and precise test in routine diagnostics has led to a cooperation with a company based in Germany and has also generated interest from large internationally operating companies,” says Uta Jappe. “Brining the BAT as a standard method in the clinic would represent a major advance in the treatment of our patients.”

The work in this project was partly funded by DZL’s Disease Area Asthma and Allergies.

Original paper: Behrends J, Schwager C, Hein M, Scholzen T, Kull S, Jappe U (2021) Innovative robust basophil activation test using a novel gating strategy reliably diagnosing allergy with full automation Allergy 76(12): 3776.

Link to the article in Allergy

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