Basophil Activation Test in IgE-Mediated Wheat Allergy: Diagnostic and Clinical Applications—A Narrative Review

TL;DR

The basophil activation test helps diagnose and monitor IgE-mediated wheat allergies by measuring basophil responses to allergens, offering better insights than traditional methods.

Contribution

This review highlights BAT's role in diagnosing complex wheat allergy cases and monitoring treatment with omalizumab.

Findings

BAT detects sensitization to specific wheat components like ω-5 gliadin and glutenin subunits.

BAT shows reduced basophil reactivity in patients on omalizumab, correlating with better clinical outcomes.

BAT is useful in diagnosing wheat-dependent exercise-induced anaphylaxis and contact urticaria.

Abstract

The basophil activation test (BAT) is an emerging tool in the diagnosis and management of IgE-mediated wheat allergies (WAs), particularly in complex or high-risk phenotypes. This narrative review explores the clinical applications of BAT across a spectrum of WA presentations, including wheat-dependent exercise-induced anaphylaxis (WDEIA), contact urticaria, and pediatric food allergy. The BAT provides a functional measure of allergen-triggered basophil activation, bridging the gap between mere sensitization and true clinical reactivity. We highlight its utility in detecting sensitization to specific wheat components such as ω-5 gliadin, glutenin subunits, and hydrolyzed wheat proteins, and its value in cases where traditional diagnostics are inconclusive. Furthermore, BAT is discussed as a dynamic biomarker in therapeutic monitoring, especially in patients receiving omalizumab, where reduced basophil reactivity correlates with improved clinical outcomes. While standardization and access remain challenges, the BAT holds significant promise as a precision diagnostic and monitoring tool in wheat allergies.

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