Basophil histamine release test for the diagnosis of cefaclor allergy

초록

Background: Cefaclor is a common cause of IgE-mediated allergic reaction. The diagnosis of cefaclor allergy is mainly based on skin prick and intradermal test (skin test) and/or specific IgE antibodies to cefaclor (sIgE). However, a subset of patients with cefaclor allergy show negative response both to skin test and to sIgE test. In this case, the diagnosis can be confirmed by oral provocation test (OPT), but it is very risky. This study was performed to evaluate the clinical value of basophil histamine release test (HR) in the diagnosis of cefaclor allergy. Methods: Patients with cefaclor allergy who were confirmed by OPT or by unquestionable clinical features were enrolled. Skin test, sIgE, and HR were conducted for all patients. For HR, isolated peripheral blood basophils were stimulated with cefaclor, and released histamine was determined by liquid chromatography-tandem mass spectrometry. Results: A total of 28 patients with cefaclor allergy were enrolled. Among them, 8 (28.6%) showed positive response to skin test, 20 (71.4%) to sIgE, and 6 (21.4%) to HR. One patient reacted positively only to HR, but not to skin test and to sIgE. Cefaclor allergy was diagnosed in 20 of 28 (71.4%) based on the results of both skin test and sIgE, but the positive rate was increased to 78.6% by adding HR to these tests. Conclusion: This study suggests that sIgE test is the most useful method for diagnosing cefaclor allergy, and that addition of HR to sIgE and skin test has only limited value in the diagnosis of cefaclor allergy.