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Review
. 2025 Feb;155(2):286-297.
doi: 10.1016/j.jaci.2024.11.023. Epub 2024 Nov 23.

Flow cytometry-based basophil and mast cell activation tests in allergology: State of the art

Didier G Ebo  1 , Rajia Bahri  2 , Alexander Eggel  3 , Vito Sabato  4 , Chiara Tontini  2 , Jessy Elst  4
Affiliations
Review

Flow cytometry-based basophil and mast cell activation tests in allergology: State of the art

Didier G Ebo et al. J Allergy Clin Immunol. 2025 Feb.

Abstract

The major challenge in allergy diagnosis is development of accessible and reliable diagnostics that can predict the clinical outcome following exposure to culprit allergen(s) or cross-reactive molecules and identification of safer alternatives than the current state-of-the-art methods. There is accumulating evidence that flow-based analyses for the quantification of activated basophils and mast cells subsequent to in vitro challenge (the basophil and mast cell activation test [BAT/MAT] or basophil activation test [BAT] and mast cell activation test [MAT]) could meet the diagnostic requirements for IgE-dependent allergies, drug hypersensitivities, and subsets of autoimmune urticaria. Furthermore, the BAT and MAT have found application in research and other nondiagnostic fields. However, appropriate use of the BAT and MAT requires understanding of the diversity of the source materials used and degranulation metrics to ensure correct test performance and interpretation of results. In this review, we provide the main applications and limitations of the BAT and MAT, as performed thus far.

Keywords: Allergy; BAT; IgE; MAT; basophil activation test; diagnosis; mast cell activation test.

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Conflict of interest statement

Disclosure statement Supported by funding from the UK Medical Research Council (to R. Bahri), UK Research and Innovation (studentship to C. Tontini), and the Swiss National Science Foundation (grant 219361 [to A. Eggel]). Disclosure of potential conflict of interest: A. Eggel is a cofounder, consultant, and shareholder of ATANIS Biotech AG and Excellergy, Inc, and has received grants from ATANIS Biotech AG unrelated to this work. D. G. Ebo, V. Sabato, and J. Elst are owners of the patent “Methods for Diagnosing Immediate Hypersensitivity Reactions” (WO 2021/191182). V. Sabato is a senior clinical researcher of the Research Foundation Flanders/Fonds Wetenschappelijk Onderzoek (grant 1804518N). D. G Ebo is a senior clinical researcher of the Research Foundation Flanders/Fonds Wetenschappelijk Onderzoek (grant 1800614N). The Antwerp University Hospital and AZ Jan Palfijn Hospital Ghent are excellence centers of the World Allergy Organization. The rest of the authors declare that they have no relevant conflicts of interest.