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\begin{document}

\title{The basophil activation test has high reproducibility between
laboratories and was well integrated in the clinical decision-making
process in a specialised centre}



\author[1]{Hannah Jaumdally}%
\author[1]{Matthew Kwok}%
\author[1]{Zainab Jama}%
\author[2]{Rochelle Hesse-Lamptey}%
\author[1]{Richard McKendry}%
\author[3]{Oliver Galvez}%
\author[3]{Yvonne Daniel}%
\author[1]{Alexandra F. Santos}%
\affil[1]{King's College London Faculty of Life Sciences and Medicine}%
\affil[2]{King's College London}%
\affil[3]{Guy's and St Thomas' NHS Foundation Trust}%


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  \date{May 19, 2024}


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\begin{abstract}
\textbf{Background:} The basophil activation test (BAT) has high
accuracy to diagnose peanut allergy (PA) and can reduce the need for
oral food challenges (OFC); however, so far it has not been incorporated
in clinical practice. \textbf{Methods:} We compared two BAT
methodologies, their performance in two separate laboratories, their
diagnostic utility and impact of BAT in clinical-decision-making in a
specialised centre. \textbf{Results:} 102 children being assessed for PA
were tested on BAT (72 allergic, 30 sensitised tolerant). There was
little internal variation (CV\textless{}15\%) and a very strong
correlation (Rs\textgreater{}0.95) between BAT performed across
laboratories. The 2 BAT methods were correlated but not interchangeable
and 19\% of cases had opposite results. The in-house BAT method (IH-BAT)
was superior, as demonstrated by its better diagnostic performance (area
under the ROC curve 0.929/0.957 versus 0.892/0.895 for CD63/CD203c),
lower number of non-responders (4\% versus 14\%), lower background
basophil activation (4\% versus 9\%) and less need for oral food
challenges (29/12 versus 37/20 for OFC/positive OFC). BAT was feasible
and well-accepted by clinicians: no patient with positive BAT was
referred for OFC; only 37\% of all tested patients needed an OFC and
14\% of these (5\% of total) reacted during OFC, which corresponded to
72/89\% decrease in OFC/positive OFC, respectively, with the integration
of BAT in the diagnostic work-up for peanut allergy.
\textbf{Conclusions:} The BAT is a robust test that can reliably be
transferred between laboratories; however, different BAT methods are not
interchangeable. BAT was well integrated in the clinical decision-making
process in a specialised centre.%
\end{abstract}%



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\textbf{Hosted file}

\verb`BAT to clinic 05.02.2022.docx`  available at \url{https://authorea.com/users/740733/articles/713450-the-basophil-activation-test-has-high-reproducibility-between-laboratories-and-was-well-integrated-in-the-clinical-decision-making-process-in-a-specialised-centre}

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