Allergy Asthma Immunol Res.  2012 May;4(3):137-142. 10.4168/aair.2012.4.3.137.

Flow Cytometry-Assisted Basophil Activation Test as a Safe Diagnostic Tool for Aspirin/NSAID Hypersenstivity

• Kim MS
• Cho YJ

• KMID: 2167065
• DOI: http://doi.org/10.4168/aair.2012.4.3.137

Abstract

PURPOSE
Aspirin and non-steroidal anti-inflammatory drugs (ASA/NSAIDs) are common causes of drug hypersensitivity. An oral provocation test is the only definitive diagnostic test. This study assessed the reliability of a flow cytometry-assisted basophil activation test (FAST) as a safe diagnostic method for ASA/NSAID-induced hypersensitivity, as its high sensitivity and specificity have been demonstrated for many other drugs.
METHODS
Eighteen patients and 11 controls were enrolled. Using a Flow-CAST kit(R) (Buhlmann Laboratories AG, Schonenbuch, Switzerland), 29 analyses with aspirin, ibuprofen, and diclofenac were performed by flow cytometry to detect double-positive staining of anti-IgE and anti-CD63. The stimulation index was defined as the activated basophil percentage after drug stimulation/basally active basophil percentage. A stimulation index> or =2 and an absolute activated basophil percentage> or =5 were considered positive.
RESULTS
Patients with hypersensitivity to ASA/NSAIDs were predominantly female, and the prevalence of atopy was higher in patients than in controls. A sensitivity of 61%, specificity of 91%, positive predictive value of 92%, and negative predictive value of 59% were achieved.
CONCLUSIONS
FAST is a useful additional method for diagnosis of hypersensitivity reactions to ASA/NSAIDs. Further development is required to increase the sensitivity of the test.

Keyword

Flow cytometry; basophil; aspirin; non-steroidal anti-inflammatory drugs; drug hypersensitivity

MeSH Terms

Antibodies, Anti-Idiotypic
Aspirin
Basophils
Diagnostic Tests, Routine
Diclofenac
Drug Hypersensitivity
Female
Flow Cytometry
Humans
Hypersensitivity
Ibuprofen
Prevalence
Antibodies, Anti-Idiotypic
Aspirin
Diclofenac
Ibuprofen

Figure

• 

  Fig. 1 Representative aspirin hypersensitivity results. (A) The cutoff point (arrow) for anti-CD63-PE was established according to the initiation of a fluorescence peak in the positive control. Shaded histogram, negative control (stimulation buffer); solid gray lines, positive control (anti-FcεRI antibody). (B) A sample stimulated with aspirin showing activation of 25.69% of basophils. (C) A sample stimulated with ibuprofen showing activation of 2.11% of basophils. (D) A sample stimulated with diclofenac showing activation of 4.57% of basophils. The SI of aspirin was >2, indicating a positive result. The percentage of activated basophils was low (<5%) upon stimulation with ibuprofen or diclofenac, indicating a negative result for each.

• 

  Fig. 2 The receiver operating characteristics (ROC) curve. According to the ROC curve, the optimal cutoff point for the stimulation index was 1.9 (arrow). The observed area under the curve was 0.72 (95% Confidence Interval, 0.53-0.93; P=0.039), which is considered fair.

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