Pros and Cons of Clinical Basophil Testing (BAT)
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Purpose of review We review basophil testing by flow cytometry with an emphasis on advantages and disadvantages.Recent findings There are many tools available to assess the presence and severity of allergic diseases in patients. For 50 years, peripheral blood basophils have been used as tools to study these diseases. It is a very accessible cell that binds IgE antibody and secretes the classical mediators responsible for the symptoms of allergic reactions. In the last decade, an even more accessible methodology, using flow cytometry, has been developed to enhance the ability to use basophils for both mechanistic and clinical diagnostics. Basophil testing has been included in diagnostics for different forms of allergies as well as to monitor disease status. A variety of studies have begun to establish both precise methods and their clinical relevance for disease diagnosis, but there remain some important questions on how to take optimal advantage of the behaviours of basophils.
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The basophil activation test is an ex vivo peripheral blood test useful for diagnosing food and drug allergy and other hypersensitivity syndromes when skin prick testing and serum specific IgE are discordant with clinical history or unavailable, and for monitoring allergen immunotherapy.
“The basophil activation test (BAT) is an ex vivo peripheral blood test that has been shown to be useful in the diagnosis of allergy to food and drugs, along with other hypersensitivity syndromes, when first-line tests (SPT and serum sIgE) are discordant with clinical history or do not exist, and for monitoring of AIT.966”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [966]
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CD‐sens: a biological measure of immunological changes stimulated by ASIT
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Early improvement in basophil sensitivity predicts symptom relief with grass pollen immunotherapy
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Self-citationIn vitro diagnosis of immediate allergic reactions to drugs: an update.
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Significant correlation between the CD63 assay and the histamine release assay in chronic urticaria
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Basophil allergen threshold sensitivity, CD-sens, is a measure of allergen sensitivity in asthma
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Immunological events in chronic spontaneous urticaria
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Human basophil chemotaxis and activation are regulated via the histamine H4 receptor
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Parameters determining the efficacy of CD32 to inhibit activation of FcεRI in human basophils
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High basophil allergen sensitivity (CD‐sens) is associated with severe allergic asthma in children
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Human basophils: a unique biological instrument to detect the allergenicity of food.
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Self-citationTransient transfection of human peripheral blood basophils
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Self-citationSequential allergen desensitization of basophils is non‐specific and may involve p38 MAPK
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Self-citationThe basophil activation test identified carminic acid as an allergen inducing anaphylaxis
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CD-Sens Can Be a Reliable and Easy-to-Use Complement in the Diagnosis of Allergic Rhinitis
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International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis
Wise, S. K., Lin, S. Y., Toskala, E., Orlandi, R. R., Akdis, C. A., Alt, J. A., Azar, A., Baroody, F. M., Bachert, C., Canonica, G. W., et al. (2018) · International Forum of Allergy & Rhinology · doi:10.1002/alr.22073 · Cited by 557 · see citing works
EAACI Molecular Allergology User's Guide 2.0
Dramburg, S., Hilger, C., Santos, A. F., Vecillas, L. D. L., Aalberse, R. C., Acevedo, N., Aglas, L., Altmann, F., Arruda, L. K., Asero, R., et al. (2023) · Pediatric Allergy and Immunology · doi:10.1111/pai.13854 · Cited by 332 · see citing works
Self-citationSantos, A. F., Alpan, O., & Hoffmann, H. J. (2021) · Allergy · doi:10.1111/all.14747 · Cited by 283 · see citing works
Self-citationBasophil Activation Test: Old and New Applications in Allergy
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Self-citationLarsen, L. F., Juel‐Berg, N., Hansen, K. S., Mills, E. N. C., van Ree, R., Poulsen, L. K., & Jensen, B. M. (2017) · Allergy · doi:10.1111/all.13243 · Cited by 55 · see citing works
“HR and passive HR are being used for allergy testing, and BAT is considered for clinical diagnostics.(4,13-15) However, it has to our knowledge not been investigated whether these three cellular allergy tests yield similar diagnostic results.”
MethodBasophils from Cancer Patients Respond to Immune Stimuli and Predict Clinical Outcome
Bax, H. J., Chauhan, J., Stavraka, C., Khiabany, A., Nakamura, M., Pellizzari, G., Ilieva, K. M., Lombardi, S., Gould, H. J., Corrigan, C. J., et al. (2020) · Cells · doi:10.3390/cells9071631 · Cited by 51 · see citing works
“…in our cancer patient cohort is similar to that described in other groups of patients whose basophils were subjected to IgE-mediated stimulation using the BAT [9,10], for example, in children evaluated for peanut allergy [13], tree and grass pollen allergies [8], and cow’s milk intolerance [71].”
Schmid, J. M., Würtzen, P. A., Siddhuraj, P., Jogdand, P. S., Petersen, C. G., Dahl, R., Erjefalt, J. S., & Hoffmann, H. J. (2020) · Allergy · doi:10.1111/all.14264 · Cited by 41 · see citing works
Self-citationAdvances in Food Allergy Diagnosis
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Self-citationOral Immunotherapy and Basophil and Mast Cell Reactivity in Food Allergy
Paranjape, A. R., Tsai, M. M., Mukai, K., Hoh, R. A., Joshi, S. A., Chinthrajah, R. S., Nadeau, K. C., Boyd, S. D., & Galli, S. J. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.602660 · Cited by 32 · see citing works
Gabler, A. M., Gebhard, J., Eberlein, B., Biedermann, T., Scherf, K. A., & Brockow, K. (2021) · Clinical and Translational Allergy · doi:10.1002/clt2.12050 · Cited by 28 · see citing works
“The upregulation of CD63 is closely associated with basophil degranulation induced by allergen stimuli.19 Hoffmann et al. (2016) reported that the upregulation of CD203c also occurs to non‐degranulation stimuli, which is not the case for CD63.”
BackgroundSelf-citationFlow cytometry–based basophil and mast cell activation tests in allergology: State of the art
Ebo, D. G., Bahri, R., Eggel, A., Sabato, V., Tontini, C., & Elst, J. (2024) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2024.11.023 · Cited by 26 · see citing works
Self-citationThe Evolution of Human Basophil Biology from Neglect towards Understanding of Their Immune Functions
Steiner, M. J., Huber, S., Harrer, A., & Himly, M. (2016) · BioMed Research International · doi:10.1155/2016/8232830 · Cited by 24 · see citing works
“[174, 175] BAT is successfully used to diagnose IgE-mediated allergies, for example, in food, hymenoptera venom, latex, and inhalant allergies.”
BackgroundTowards standardizing basophil identification by flow cytometry
Sønder, S. U., Plassmeyer, M. L., Loizou, D., & Alpan, O. (2023) · Frontiers in Allergy · doi:10.3389/falgy.2023.1133378 · Cited by 25 · see citing works
“inclusiveness, (3) Correlation between the different approaches, (4) Correlation with CBC results, (5) Stability of the markers, (6) Effect of stimulation.”
BackgroundGabler, A. M., Gebhard, J., Norwig, M.-C., Eberlein, B., Biedermann, T., Brockow, K., & Scherf, K. A. (2022) · Frontiers in Allergy · doi:10.3389/falgy.2022.822554 · Cited by 19 · see citing works
Self-citationImmune monitoring for precision medicine in allergy and asthma
Boyd, S. D., Hoh, R. A., Nadeau, K. C., & Galli, S. J. (2017) · Current Opinion in Immunology · doi:10.1016/j.coi.2017.08.007 · Cited by 19 · see citing works
“Other promising non-invasive immune monitoring tests include basophil activation tests (BATs), which measure blood basophil activation upon allergen challenge [18 ,19].”
Validation of inducible basophil biomarkers: Time, temperature and transportation
Kim, T., Yu, J., Li, H., Scarupa, M. D., Wasserman, R. L., Economides, A., White, M. V., Ward, C., Shah, A. N., Jones, D. H., et al. (2021) · Cytometry Part B Clinical Cytometry · doi:10.1002/cyto.b.21991 · Cited by 18 · see citing works
“The consensus is that CD63 is the best marker because it is directly related to histamine release and it easy to gate since it is expressed on a distinct positive population (Amano et al., 2001; Dvorak et al., 1983; Hoffmann et al., 2016; MacGlashan Jr, 2010; MacGlashan Jr, 2012).”
BackgroundInfluentialApplications of basophil activation test in paediatric allergic diseases
Dodi, G., Paola, D. G. D., Armando, D. L., Simeone, P., Domenico, D. B., D’Ascanio, F., Pillo, S. D., Francesco, C., Lanuti, P., & Marina, A. (2024) · World Allergy Organization Journal · doi:10.1016/j.waojou.2024.100998 · Cited by 14 · see citing works
Chirumbolo, S., Bjørklund, G., & Vella, A. (2017) · Advances in respiratory medicine · doi:10.5603/arm.2017.0032 · Cited by 10 · see citing works
“In the very recent years, the basophil activation test (BAT) has become an outstanding tool to diagnose allergy, though still with some contradictory opinion [1].”
BackgroundMethodological cutoff of basophil activation test and basophil activation test diagnostic value
Dreborg, S. K. G. (2018) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2017.10.038 · Cited by 10 · see citing works
Basophil activation test; User's manual
Sønder, S. U., Plassmeyer, M. L., Schroeder, N., Peyton, S., Paige, M. A., Girgis, M. J., Safi, H., & Alpan, O. (2025) · Journal of Immunological Methods · doi:10.1016/j.jim.2025.113815 · Cited by 9 · see citing works
Hypersensitivity reactions to anti-SARS-CoV-2 vaccines: Basophil reactivity to excipients
Pignatti, P., Ramirez, G. A., Russo, M., Marraccini, P., Nannipieri, S., Asperti, C., Torre, F. D., Tiri, A., Gatti, B. M., Gurrado, A., et al. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.06.039 · Cited by 7 · see citing works
Possible alternative strategies to implement basophil activation testing in multicentric studies
Bourgoin, P., Dupont, T., Agabriel, C., Carsin, A., Verles, A., Cabanski, M., Vitaliti, A., & Busnel, J. (2024) · Cytometry Part B Clinical Cytometry · doi:10.1002/cyto.b.22172 · Cited by 6 · see citing works
“Recommendations indicate that BAT should ideally be performed within 4 h of blood collection, as basophil reactivity decreases considerably over time (Hoffmann et al., 2016; Sturm et al., 2009).”
Basophil activation: theoretical aspects and use in the diagnosis of allergic diseases
Бычкова, Н. В. (2021) · Medical Immunology (Russia) · doi:10.15789/1563-0625-bat-2174 · Cited by 6 · see citing works
Yamada, T., Suzuki, T., Murase, R., Nagata, H., & Kosugi, S. (2018) · A&A Practice · doi:10.1213/xaa.0000000000000774 · Cited by 6 · see citing works
Bourgoin, P., & Busnel, J. (2023) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2023.08.029 · Cited by 5 · see citing works
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Vera-Berrios, R. N., Feary, J. R., & Cullinan, P. (2018) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0000000000000506 · Cited by 5 · see citing works
Rasmussen, P., Spillner, E., & Hoffmann, H. J. (2019) · Immunology Letters · doi:10.1016/j.imlet.2019.04.003 · Cited by 5 · see citing works
Self-citationBasophil FceRI expression—A management tool in anti‐IgE treatment of allergic asthma
Rubak, S., Bonne, N. L., Hjerrild, B., & Hoffmann, H. J. (2024) · Pediatric Pulmonology · doi:10.1002/ppul.27206 · Cited by 3 · see citing works
Self-citationIn vitro diagnostics of drug allergies
Glässner, A., Weßollek, K., Yazdi, A. S., & Sachs, B. (2024) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15466 · Cited by 3 · see citing works
“23,24 The evaluation of the BAT has not yet been standardized for all drugs.”
Akiki, P., Dedeken, L., Ferster, A., Doyen, V., Dupire, G., Nagant, C., Smet, J., Ghorra, N., Ruth, I., Lauwers, M., et al. (2024) · Frontiers in Allergy · doi:10.3389/falgy.2023.1328227 · Cited by 2 · see citing works
Groffmann, J., Hoppe, I., Ahmed, W. A. N., Hoang, Y. N. T., Gryzik, S., Radbruch, A., Worm, M., Beyer, K., & Baumgrass, R. (2024) · Diagnostics · doi:10.3390/diagnostics14171959 · Cited by 2 · see citing works
Shahrani, M. M. A., Abohassan, M., Gahtani, R. M., Alshahrani, M. Y., Suliman, M., Ahmad, I. S., & Saeed, M. (2023) · Journal of Biomolecular Structure and Dynamics · doi:10.1080/07391102.2023.2294377 · Cited by 2 · see citing works
“When Fc e RI, bound IgE are cross linked on basophils, activation of ITAMs occurs through excess phosphorylation on the Fc e RI bc subunits and SH2-domains of kinases (Hoffmann et al., 2016).”
Flow-assisted basophil activation test for sevoflurane hypersensitivity
Petrișor, C., Sfichi, M., Mureşan, M., & Hagău, N. (2017) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000000676 · Cited by 2 · see citing works
Aetiopathogenesis of Urticaria
Grattan, C. E. H., & Church, M. K. (2021) · Springer eBooks · doi:10.1007/978-3-030-84574-2_2 · Cited by 1 · see citing works
Kumar, A. (2025) · Biotechnology and Applied Biochemistry · doi:10.1002/bab.70037 · Cited by 1 · see citing works
Petrișor, C., Gherman, N., Sfichi, M., Mureşan, M., & Hagău, N. (2017) · A & A Case Reports · doi:10.1213/xaa.0000000000000552 · Cited by 1 · see citing works
Basophil Stimulation and Signaling Pathways
Knol, E. F., & Gibbs, B. F. (2020) · Methods in molecular biology · doi:10.1007/978-1-0716-0696-4_25 · Cited by 1 · see citing works
Self-citationKim, T., Wasserman, R. L., Alpan, O., Shah, A. N., & Jones, D. (2020) · medRxiv · doi:10.1101/2020.01.15.20017541 · Cited by 1 · see citing works
Perioperative management of allergic risks
Cheng, V. W. K., & Ng, A. C. K. (2022) · Anaesthesia & intensive care medicine · doi:10.1016/j.mpaic.2022.08.011
Burygina, E. V., Kozlova, Y. I., Frolova, E. V., Uchevatkina, A. E., Aak, O. V., Filippova, L. V., Melnikova, А. V., Raznatovsky, K. I., Vasilyeva, N. V., & Климко, Н. Н. (2023) · Russian Journal of Clinical Dermatology and Venereology · doi:10.17116/klinderma202322021186
Gabler, A. M., & Scherf, K. A. (2023) · Lebensmittelchemie · doi:10.1002/lemi.202352242
In‐vitro‐Diagnostik von Arzneimittelallergien
Glässner, A., Weßollek, K., Yazdi, A. S., & Sachs, B. (2024) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15466_g
MAST CELLS, THE EFFECTOR CELLS OF IgE-MEDIATED ALLERGY
Nikolov, G., Emilova, R., Todorova, Y., Milcheva, D., & Nikolova, M. H. (2025) · PROBLEMS of Infectious and Parasitic Diseases · doi:10.58395/292bv823
“It is still not recommended to be used as a single diagnostic tool due to various limitations, such as differences in cut-off values and lack of standard - ized interpretation protocols for certain allergens (51).”
Shehan, J. N., & Brook, C. D. (2025) · Springer eBooks · doi:10.1007/978-3-031-93455-1_15
Li, W., Qu, X., 蔺丽慧, Wang, J., Li, J., Yin, Y., Ge, Y., Zhao, J., Liu, Y., Li, L., et al. (2026) · Journal of Asthma and Allergy · doi:10.2147/jaa.s577679
“Some studies advocate processing within 4 h of collection at RT, 15,17 while others demonstrate 24 h stability at 4°C. 18 Critically, no prior study has compared temperature effects across different stimuli within a unified framework, preventing evidence-based standardization for routine laboratory workflows involving…”
InfluentialPeeters, L., Elst, J., & Ebo, D. G. (2026) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2026.2695167
“Furthermore, 10–20% of individuals exhibit a non-releaser phenotype, which at the molecular level, is likely characterized by a deficiency in spleen tyrosine kinase (Syk) protein expression [14,15].”
Buono, E. V., Canducci, N., Carbone, R., Menzella, M., Montanari, A. M., Carretta, T., Fainardi, V., Caffarelli, C., & Esposito, S. (2026) · Biomedicines · doi:10.3390/biomedicines14071608
Chauhan, J., Vlasova, S., Chenoweth, A. M., Josephs, D. H., Bax, H. J., & Karagiannis, S. N. (2026) · Allergy · doi:10.1111/all.70457
Flow Cytometry in Human Cells Exposed to Tick Salivary Proteins
González-García, A., Mazuecos, L., Vaz‐Rodrigues, R., & de la Fuente, J. (2026) · Methods in molecular biology · doi:10.1007/978-1-0716-5635-8_10
- Authors
- Hoffmann, H. J., Knol, E. F., Ferrer, M., Mayorga, L., Sabato, V., Santos, A. F., Eberlein, B., Nopp, A., & MacGlashan, D.
- Affiliations
- Aarhus University (DK)
- University Medical Center Utrecht (NL)
- University of Antwerp (BE)
- St Thomas' Hospital (GB)
- Technical University of Munich (DE)
- Karolinska University Hospital (SE)
- Johns Hopkins University (US)
- Corresponding author
- Hoffmann, Hans Jürgen
- ORCID
- Venue
- Current Allergy and Asthma Reports
- Published
- 2016-07-13
- Volume
- 16
- Issue
- 8
- Pages
- 56-56
- ISSN
- 1529-7322 (ISSN-L)
- 1534-6315
- OpenAlex
- W2472226085
- Cited by
- 50
- References
- 159
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 7 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 1 · 2018: 6 · 2017: 5 · 2016: 1
- FWCI
- 0.42
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- Current Allergy and Asthma Reports (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Medical Research Council (MR/M008517/1)
- National Institute of Allergy and Infectious Diseases (U01AI100952)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- basophils, allergic diseases, IgE, allergic inflammation, flow cytometry, allergy diagnosis, disease surveillance, basophil activation
- MeSH terms
- Basophils, Flow Cytometry, Humans, Hypersensitivity
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