Are Basophil Activation Test (BAT) and IgE Levels Useful Tools in Confirming Penicillin Allergy? Novel Diagnostic Approach in Beta-Lactams Hypersensitivity Reactions: A Systematic Review

Abstract

Approximately 15% of the population in developed countries report a penicillin allergy in their medical history. However, this changes considerably following a comprehensive allergological evaluation. Numerous studies have shown that a true penicillin allergy is confirmed in only about 8% of individuals. Recommended diagnostic protocols are usually complex and time-consuming, as they rely primarily on in vivo diagnostic approaches, such as skin testing and drug provocation tests. To date, there are no clear guidelines regarding the implementation of in vitro tests in diagnostic algorithms for patients with suspected penicillin allergies. Currently available in vitro methods are characterized by limited sensitivity and specificity. On the other hand, they offer the potential to reduce the need for drug provocation testing, which remains the gold standard but carries an inherent risk of inducing clinical reactions. Consequently, researchers continue to explore methodological improvements aimed at enhancing the diagnostic performance and clinical utility of these tests. In this systematic review, we analyze the current possibilities and limitations of the basophil activation test (BAT) and the measurement of specific IgE (sIgE) antibodies, as well as their potential role in the routine diagnostic workup of patients with suspected immediate hypersensitivity reactions to penicillins.