BackgroundDelabelling pathways offer confirmatory diagnosis and can prevent unnecessary second‐line therapies or drug desensitization procedures after chemotherapeutic hypersensitivity reactions (CHT‐HSRs). However, these pathways rely on risky in vivo tests. Data on whether in vitro tests could be helpful are scarce. We assessed the role of basophil activation test (BAT) in the diagnosis of HSRs to platin salts (PSs) and taxanes (TXs) in a well‐defined population featuring varied endophenotypes and severities of HSRs.MethodsWe conducted a 3‐year‐long multicentric, prospective study with 121 suspected‐immediate CHT‐HSR patients. The allergy workup included clinical history (initial reaction based on Type I, cytokine release syndrome, and mixed phenotype's symptoms and if unable to fit in any of these, as “indeterminate”), skin testing (ST), and drug provocation testing (DPT), provided risk assessment was favorable. Final diagnosis classified patients as “hypersensitive,” “non‐hypersensitive,” or “inconclusive.” We performed BAT using CD63 and CD203c as activation markers in patients and controls. Patients underwent DPT regardless of BAT results to prevent bias.ResultsST positivity significantly correlated with skin involvement, Type I phenotype, cancer recurrence, and lifetime exposures before reactions. DPTs were negative in all indeterminate phenotype patients (p = .02) and those considered low‐risk, whereas they were negative in 62% moderate‐risk patients. 55% were confirmed as hypersensitive (mainly Type I reactions, p < .0001), 24% as non‐hypersensitive (mainly TXs and indeterminate phenotypes), and 21% as inconclusive. BAT showed 79% sensitivity in Type I IgE‐mediated reactions to PSs with a high correlation to ST.ConclusionsBAT is a promising tool for delabelling and endotyping CHT‐HSRs, especially Type I reactions to PSs, possibly identifying patients at risk of positive DPT. ST seems useful in confirming CHT‐HSRs, especially PS‐induced reactions, and DPT remains the gold standard, being essential even in moderate‐risk patients.

中文翻译：

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嗜碱性粒细胞活化试验是诊断对铂盐和紫杉烷类药物的速发型反应的补充工具


背景去标签通路提供确诊，并可以防止化疗超敏反应 （CHT-HSR） 后不必要的二线治疗或药物脱敏程序。然而，这些途径依赖于有风险的体内测试。关于体外测试是否有帮助的数据很少。我们评估了嗜碱性粒细胞活化试验 （BAT） 在铂盐 （PS） 和紫杉烷 （TX） 诊断 HSR 中的作用，该人群具有不同的 HSR 内表型和严重程度。过敏检查包括临床病史 （基于 I 型、细胞因子释放综合征和混合表型症状的初始反应，如果无法适应其中任何一种，则为“不确定”）、皮肤试验 （ST） 和药物激发试验 （DPT），前提是风险评估良好。最终诊断将患者分为 “过敏”、“非过敏” 或 “不确定”。我们使用 CD63 和 CD203c 作为患者和对照的激活标志物进行 BAT。无论 BAT 结果如何，患者都接受了 DPT 以防止偏倚。结果ST 阳性与皮肤受累、I 型表型、癌症复发和反应前终生暴露显著相关。所有不确定表型患者 （p = .02） 和被认为低风险的患者的 DPT 均为阴性，而 62% 的中风险患者的 DPT 为阴性。55% 被确认为超敏反应（主要是 I 型反应，p < .0001），24% 为非超敏反应（主要是 TX 和不确定表型），21% 为不确定。BAT 在 I 型 IgE 介导的 PS 反应中显示出 79% 的敏感性，与 ST 高度相关。结论BAT 是一种很有前途的工具，可用于 CHT-HSR 的去标签和内型分型，尤其是对 PS 的 I 型反应，可能识别有阳性 DPT 风险的患者。ST 似乎有助于确认 CHT-HSRs，尤其是 PS 诱导的反应，并且 DPT 仍然是金标准，即使在中等风险患者中也是必不可少的。