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Peer-reviewedCC BYJA clinical reports

Recurrent anaphylaxis highlighting methodological variability and diagnostic challenges in the basophil activation test: a case report.

  • Kento Okutomi1
  • Yuki Sugiyama2
  • Asako Nitta1
  • Motonobu Kimizuka1
  • Michiaki Yamakage1
  1. 1Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Sapporo, Hokkaido, 060-8543, Japan.
  2. 2Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Sapporo, Hokkaido, 060-8543, Japan. [email protected].
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Abstract

Background

The basophil activation test (BAT) is an adjunct in identifying causative agents of anaphylaxis. However, its limited sensitivity and methodological variability may lead to inaccurate allergen identification.Case presentation

A 74-year-old woman developed anaphylaxis during anesthetic induction. BAT performed 1 week after the anaphylaxis was negative at 1-hour incubation, whereas 24-hour incubation showed slight increase in basophil activation rates with propofol (7.9%), levobupivacaine (6.1%), with cefazolin remaining negative (0.2%). At the second surgery, propofol and levobupivacaine were avoided, whereas cefazolin was re-administered, resulting in recurrent anaphylaxis. Subsequent skin testing performed 6 weeks after the second anaphylaxis was positive for cefazolin. BAT performed with a 15-minute incubation using higher drug concentrations was also positive for cefazolin (14.3%).Conclusions

Early testing after anaphylaxis, prolonged incubation, and suboptimal drug concentrations may compromise the accuracy of BAT results. This case underscores that methodological standardization and careful interpretation are essential for reliable BAT results.

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Cite

BibTeXRIS
BibTeX
@article{okutomi2026recurrent,
  title = {{Recurrent anaphylaxis highlighting methodological variability and diagnostic challenges in the basophil activation test: a case report.}},
  author = {Kento Okutomi and Yuki Sugiyama and Asako Nitta and Motonobu Kimizuka and Michiaki Yamakage},
  journal = {JA clinical reports},
  year = {2026},
  month = aug,
  doi = {10.1186/s40981-026-00872-6},
  url = {https://europepmc.org/article/MED/42972201},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Recurrent anaphylaxis highlighting methodological variability and diagnostic challenges in the basophil activation test: a case report.
AU  - Kento Okutomi
AU  - Yuki Sugiyama
AU  - Asako Nitta
AU  - Motonobu Kimizuka
AU  - Michiaki Yamakage
PY  - 2026
DA  - 2026/08/06
JO  - JA clinical reports
DO  - 10.1186/s40981-026-00872-6
UR  - https://europepmc.org/article/MED/42972201
AB  - Background  The basophil activation test (BAT) is an adjunct in identifying causative agents of anaphylaxis. However, its limited sensitivity and methodological variability may lead to inaccurate allergen identification.Case presentation  A 74-year-old woman developed anaphylaxis during anesthetic induction. BAT performed 1 week after the anaphylaxis was negative at 1-hour incubation, whereas 24-hour incubation showed slight increase in basophil activation rates with propofol (7.9%), levobupivacaine (6.1%), with cefazolin remaining negative (0.2%). At the second surgery, propofol and levobupivacaine were avoided, whereas cefazolin was re-administered, resulting in recurrent anaphylaxis. Subsequent skin testing performed 6 weeks after the second anaphylaxis was positive for cefazolin. BAT performed with a 15-minute incubation using higher drug concentrations was also positive for cefazolin (14.3%).Conclusions  Early testing after anaphylaxis, prolonged incubation, and suboptimal drug concentrations may compromise the accuracy of BAT results. This case underscores that methodological standardization and careful interpretation are essential for reliable BAT results.
SN  - 2363-9024
ER  -