In 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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BACKGROUND: In many cases of drug allergy, it is necessary to do in vitro test, for several reasons. BAT (basophil activation test) is a very useful weapon in these cases. In many iv. or im. depot preparations, the culprit of the allergic reaction is an excipient, and not the main component.
METHODS: A 37-year-old male, suffering from a Klinefelter syndrome needed treatment with a preparation of undecanoate of testosterone (Reandron). With the last administered dose, he suffered an anaphylactic shock with Kounis syndrome. The patient declined any in vivo studies, so we thought of BAT as a possibility for the diagnosis. The results were remarkable, showing a very high positivity to castor oil.
CONCLUSIONS: This is the second case in the world of anaphylaxis to a preparation of Testosterone, and the first one with the castor oil (also called Cremophor or Kolliphor) as responsible. El BAT was essential for the diagnosis and ulterior treatment of this patient. This is the first time, that this study with BAT, has been done with a Testosterone preparation.
Introducción: En muchos casos de alergia a medicamentos, es necesario realizar pruebas in vitro por diversos motivos. La PAB (prueba de activación de basófilos) es un arma útil en estos casos. Reporte de caso: Se trata de un hombre de 37 años en tratamiento con undecanoato de testosterona relacionado a síndrome de Klinefelter; que al momento de la última minsitración de la dosis, el paciente sufrió un choque anafiláctico acompañado de síndrome de Kounis. Por la necesidad de seguir con el tratamiento con testosterona, decidimos recurrir a la PAB para el diagnóstico, y los resultados fueron concluyentes, se documentó positividad al aceite de ricino. Conclusiones: A nivel mundial, este es el segundo caso de anafilaxia asociado a undecanoato de testosterona y el primero donde el aceite de ricino ha sido el responsable. La PAB se hizo necesaria para el diagnóstico y el posterior tratamiento de este paciente.

BACKGROUND: Myeloid neoplasms with platelet-derived growth factor receptor β (PDGFRB) rearrangement usually present with eosinophilia in the peripheral blood and bone marrow. Here we report a case of systemic mastocytosis related myeloid neoplasms with basophilia and PRKG2-PDGFRB fusion gene.
METHODS: A 53-year-old male patient felt fatigue with thrombocythemia and normal hemoglobin over 2 years. Considering the possibility of primary thrombocytosis, the patient was treated with hydroxyurea and interferon. Then the therapy was stopped due to adverse events and worsen condition.
METHODS: Acute myelogenous leukemia (AML) diagnosis was confirmed by bone marrow morphology and flow cytometry. PDGFRB rearrangement was detected by fluorescence in situ hybridization (FISH) test, with chromosome karyotype 46,XY,t(4:5)(q21:q33). PRKG2-PDGFRB fusion was observed by next generation sequencing (NGS) and verified by RT-PCR followed by Sanger sequencing. The results of bone marrow aspiration, bone marrow biopsy, and immunophenotyping showed systemic mastocytosis-related myeloid tumor with basophilia.
METHODS: Imatinib 400 mg/d was given on the day of admission. Azacitidine 75 mg/m2 was given for induction therapy for 10 days, and followed by one course of DHAG consolidating therapy. Imatinib was taken orally continuously.
RESULTS: On the 8th day of treatment, the patient\'s diet and fatigue improved. The hematological and bone marrow morphological remission was achieved on the 25th day. Cytogenetic complete remission was achieved 3 months later and continued to present (December 20, 2020). PRKG2-PDGFRB fusion gene turned negative 7 months later from diagnosis.
CONCLUSIONS: Patients with increased basophilic granulocyte and/or mast cells in peripheral blood and/or bone marrow should be screened for PDGFRB abnormality and myeloid or lymphatic tumor. Patients bearing PDGFRB abnormality have a good response to imatinib.

BACKGROUND: Thiocolchicoside is a muscle relaxant, anti-inflammatory, and analgesic. Administered orally, intramuscularly, or topically, this drug is used in the symptomatic treatment of muscular spasms and rheumatologic disorders. Despite its extensive use, thiocolchicoside is a very rare sensitizer.
OBJECTIVE: To evaluate IgE-mediated reaction to thiocolchicoside by basophil activation test.
METHODS: Allergological work-up with skin prick tests, intradermal tests and basophil activation test with thiocolchicoside.
RESULTS: We report the first case of immediate reaction to thiocolchicoside confirmed by basophil activation test in addition to positive skin tests.
CONCLUSIONS: BAT can be considered a complementary diagnostic tool to demonstrate an IgE-mediated reaction also for muscle relaxant drugs.

An analytical method to quantify lincomycin in human blood samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been developed and validated. The selected method was based on a protein precipitation extraction (PPE) with methanol. Instrumental determination was carried out by LC-MS/MS, with quantification based on the internal standard method. Linearity for lincomycin was established in the concentration range of 5-100 ng/mL. The limit of detection (LOD) and limit of quantification (LOQ) were 0.2 and 1 ng/mL, respectively. Analyte recoveries were in the range of 72.70%-84.13% for spiked blood samples. The accuracies ranged between 92.82% and 100.40%, and the intraday and inter-day precisions ranged between 1.19% and 6.40%, respectively. The developed method was applied to an authentic allergy case of lincomycin. By testing the lincomycin content in the venous blood of the deceased and combined with the pathological test results, lincomycin acute allergy appeared to be the most likely cause of death. The acquired results confirm that the developed method is capable of identifying and quantifying lincomycin in human blood and can be suitable for the detection of allergy cases in clinical or forensic science.

Drug-induced lung injury is defined as a respiratory disorder. The usefulness of the basophil activation test (BAT) for drug allergy-related cases was recently reported. The patient was an 82-year-old woman who had been taking Daisaikoto and Yokukansan (herbal medicines) 3 months before developing dry cough. She was admitted to our hospital with an initial diagnosis of pneumonia with elevated serum LDH, KL-6, and IgE. Chest CT showed bilateral ground-glass opacities. Her bronchoalveolar lavage fluid showed increased eosinophils. Finally, a BAT was positive for both medications. Based on the findings, the patient was diagnosed with Daisaikoto- and Yokukansan-induced lung injury. The current case suggests that the BAT may be useful for the diagnosis of drug-induced lung injury.

This is a case report of anaphylaxis in which the basophil activation test (BAT) was used to identify the etiological agent. Although skin tests are considered the most effective methods for identifying anaphylactic triggers, the test itself presents a risk of inducing anaphylaxis. The BAT is advantageous because of its inherent lack of risk, high sensitivity and specificity to identify the suspected anaphylactic agents, and diagnostic accuracy comparable to conventional skin testing. Therefore, in the future, the BAT is likely to become the preferred test for the detection of allergens over conventional skin tests.

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Pericardial effusion associated with transient abnormal myelopoiesis in Down\'s syndrome neonates needs to be diagnosed in a timely manner, and the comorbidities must be treated to prevent mortality. To our knowledge, the occurrence of basophilic/eosinophilic pericardial effusion without an increase of these cells in the peripheral blood and with no evidence of associated hypothyroidism is rare.