• Mahanoor Baig, Nagesh C Nanjappa, Griffith B Perkins, Rachel Di Lernia, Venkatesan Thiruvenkatarajan, and Pravin Hissaria.
• Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia.
• Anaesth Intensive Care. 2024 Jul 1; 52 (4): 256263256-263.

AbstractIn Australia, neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Current investigation of suspected anaphylaxis includes tryptase levels, serum immunoglobulin E (IgE) levels, and skin testing, including intradermal testing and skin prick testing. The gold standard for the diagnosis of a hypersensitivity reaction is a challenge test, but this poses a risk to patient safety. An alternative test, known as the basophil activation test (BAT) is a form of cellular in vitro testing using flow cytometry to measure the degree of basophil degranulation within a sample of blood following exposure to an allergen. This acts as a surrogate marker for mast cell and basophil activation, thereby identifying IgE-mediated allergy. It is most commonly used to supplement equivocal findings from initial in vitro testing to assist in confirming the diagnosis of a hypersensitivity reaction and identify the causative agent. We present a case series in which five patients with suspected anaphylaxis underwent a BAT, demonstrating its role and limitations in allergy testing within Australia.

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