THE BASOPHIL ACTIVATION TEST IN THE DIAGNOSIS AND MANAGEMENT OF ADVERSE DRUG REACTIONS IN THE ELDERLY

Background: The use of multi-therapeutic regimes in the elderly predisposes to frequent adverse drug reactions, related to pharmacodynamic, pharmacokinetic and hypersensitivity mechanisms, with immunological or still unknown pathogenesis for the latter. Objective: The objective of the present study was to evaluate the predictive value of the basophil activation test, aiming at: diagnosing and preventing the risk of onset of IgE-mediated reactions or potential cross reactions between medications, making a therapeutic choice 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 proven hypersensitivity. BAT has resulted useful for the diagnosis of those hypersensitivity reactions that do not recognize an IgE mediated mechanism, as in the case of NSAIDs. The test showed a higher sensitivity compared to the results in literature, for both antibiotics and NSAIDs, with a slightly lower specificity. In the A group 24 out of 37 were positive with the Flow Cast to at least one of the tested drugs; in 7 cases the result was positive to only one drug. In the B group 13 out of 24 patients showed significant basophil cells’ activations to the drug responsible of the adverse reaction. In the C Group 2 patients showed activations over the the established cut off for ampicillin and amoxicillin and 4 to aspirin (2 cases), metamizol and ibuprofen. Conclusion: 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.