Abstract
The basophil activation test (BAT) is gaining increasing relevance as an ex vivo functional assay in allergy to evaluate IgE-mediated hypersensitivity reactions to food allergens, venoms, and drugs and to monitor tolerance induction. Establishing universal standard operating protocols has been difficult, due to several challenges including variable activation markers, positive control selection, the need for processing fresh blood samples, and the existence of non-releasing individuals. In oncology, BAT is also an emerging promising diagnostic and management tool to assess hypersensitivity reactions to biologics and chemotherapy agents, monitor drug tolerance in desensitisation, and predict and address the safety of novel anti-cancer IgE-based therapeutics. This position paper highlights the emerging significance of BAT in AllergoOncology, in facilitating therapy monitoring, biomarker discovery, and risk stratification. Capitalising on long-acquired expertise in the development of BAT for allergy, we propose research directions and routes to clinical applications of this highly promising tool in AllergoOncology. We advocate the need for enhanced focus on addressing standardisation challenges and leveraging outputs for precision medicine. By linking allergy and oncology, the key remaining limitations can be addressed, with the aim of realising the significant promise of BAT as a robust tool to enhance personalised care in allergy and AllergoOncology.
| Original language | English |
|---|---|
| Journal | Allergy |
| DOIs | |
| Publication status | E-pub ahead of print - 12 Jun 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s). Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Funding
All authors have read and approved the position paper. R.B., L.V., A.P., E.I., T.W.J.R., F.L.S., and C.M. declare no conflicts of interest. A.F.S. reports grants from Medical Research Council (MR/M008517/1; MC/PC/18052; MR/T032081/1), Food Allergy Research and Education (FARE), the Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (NIAID, NIH), Asthma UK (AUK\u2010BC\u20102015\u201001), BBSRC, Rosetrees Trust, and the NIHR through the Biomedical Research Centre (BRC) award to Guy's and St Thomas' NHS Foundation Trust, during the conduct of the study; personal fees from Thermo Scientific, Nestle, Novartis, Allergy Therapeutics, IgGenix, and Mabylon, as well as research support from Thermo Fisher Scientific through a collaboration agreement with King's College London. S.N.K. is the academic founder and shareholder of Epsilogen Ltd. (formerly IGEM Therapeutics Ltd.) and has received funds from IGEM Therapeutics Ltd/Epsilogen Ltd. H.J.B. is employed through a fund provided by Epsilogen Ltd. S.N.K. and H.J.B. are inventors of patents on antibody technologies. J.C. has been employed through a fund provided by Epsilogen Ltd. C.B. received honoraria for presentations from Allergy Therapeutics, Bencard, HAL Allergy, and SCS. E.J.J. declares inventorship in patents on immunoBON, owned by Biomedical International \u2009+\u2009D, Vienna, Austria, of which she is a shareholder. She received honoraria for presentations from Allergy Therapeutics, AllergoPharma, Bencard Allergie, Meda, Menarini, Roxall, Santen, Sanofi, and ThermoFisher. U.J. has received a hotel accommodation and catering for a lecture and chairing of a workshop organized by ALK Abello. The honorarium went to her institution, the R.C.B. Her research on molecular allergology is funded by the Federal Ministry of Education and Science, the Federal Ministries of Technology, Economy and Technology, Food and Agriculture (BMEL), the German Research Foundation, and the Kanert Foundation. F.R. received a Pathways in Type 2 Inflammation Research Grant from Sanofi/Regeneron; he is Editor\u2010in\u2010Chief of the European Journal of Pharmacology (Elsevier). M.P. received honoraria for presentations from ThermoFisher Scientific and LETI Pharma SLU. KH has received consultancy or lecture fees from ALK\u2010Abello, Allergopharma, Blueprint, Cogent, KalVista, LEO Pharma, Menarini, Novartis, Pfizer, Sanofi, Takeda, and Thermo Fisher, travel support from Allergopharma and Blueprint, and research funding from Thermo Fisher. M.C. declares Telios: TL\u2010895 Trial PI BWH, AAAAI Foundation Research Chair, Editor in Chief of Current Allergy and Asthma Reports, UpToDate: Author, NIH: Allergy Data and Safety Monitoring Board (DSMB), BluePrint: BLU\u2010285 and BLU\u2010263 Studies PI BWH, Consultant for Daiichi Sankyo, and Cogent Biosciences: SUMMIT Trials. EFK received honoraria for presentations for Thermo Fisher Scientific, Glaxo Smith Kline, Astra Zeneca, and Sanofi. R This position paper was supported by the European Academy for Allergy and Clinical Immunology (EAACI) under the EAACI Task force \u201CGranulocytes (mast cells, basophils, neutrophils eosinophils): understanding their roles in allergy and tumour immunity\u201D within the Working group for AllergoOncology within the Basic Immunology Section (2024). The authors would like to thank EAACI for financial support in the development of this position paper. S.N.K. has projects supported by the Medical Research Council (MR/L023091/1, MR/V049445/1, and MR/R015643/1), the Biotechnology and Biological Sciences Research Council (BB/T008709/1); Breast Cancer Now (147; KCL\u2010BCN\u2010Q3); the Cancer Research UK King's Health Partners Centre at King's College London (C604/A25135); The Guy's and St Thomas's Foundation Trust Charity (Melanoma Special Fund, 573); Innovate UK (463087); the British Skin Foundation (006/R/22); Worldwide Cancer Research (24\u20100087); Cancer Research UK (C30122/A11527 and C30122/A15774). S.N.K. has projects supported by the King's Health Partners Centre for Translational Medicine. The views expressed are those of the author(s) and not necessarily those of King's Health Partners. U.J. has projects funded by the German Research Foundation (DFG) (JA 1007/2\u20133), the Federal Ministry of Education and Science (BMBF) (D.Z.L. and INDICATE\u2010FH), and the Federal Ministry of Food and Agriculture (BMEL) (AptaSens). M.P. is employed by Hospital Cl\u00EDnic de Barcelona, Spain, and has projects funded by Instituto Carlos III (ISCIII) and co\u2010funded by the European Union (PI19/00710 and PI22/01469) and RICORS (RD21/0002/0058 and RD24/0007/0010) from ISCIII co\u2010founded by the European Union. A.P. is financially supported by the Action Lions Vaincre le Cancer association, by FNRS\u2010T\u00E9l\u00E9vie (TLV 2023 RESTAGE) and by Luxembourg National Research Fund (FNR) CORE program (C24/BM/18858278). C.M. has a contract Nicolas Monardes Program (RC0004\u20102021) and projects PI18/00288 from ISCIII co\u2010funded by the European Regional Development Fund (ERDF) \u201CUna manera de hacer Europa\u201D \u201CAndaluc\u0131a se mueve con Europa\u201D, and PI21/00346 and RICORS (RD21/0002/0008 and RD24/0007/0024) from ISCIII co\u2010founded by the European Union. K.H. has projects supported by the Swiss National Science Foundation (project no. 310030_207705) and by the EU\u2010H2020\u2010MSCA\u2010COFUND EURIdoc programme (project no. 101034170). F.L.S. has projects supported by the Israel Science Foundation (ISF) Grant no. 343/22 and the Emalie Gutterman Memorial Endowed Fund (USA). This work was supported by the European Academy of Allergy and Clinical Immunology. Funding:
| Funders | Funder number |
|---|---|
| Novartis | |
| AllergoOncology | |
| NIHR | |
| Kanert Foundation | |
| King's Health Partners Centre for Translational Medicine | |
| Allergopharma and Blueprint | |
| Federal Ministry of Education and Science | |
| Federal Ministry of Food and Agriculture | |
| BMEL | |
| Instituto Carlos III | |
| BBSRC | |
| IgGenix | |
| German Research Foundation | |
| Emalie Gutterman Memorial Endowed Fund | |
| Food Allergy Research and Education | |
| European Academy of Allergy and Clinical Immunology | |
| NIAID | |
| Guy's and St Thomas's Foundation Trust Charity | |
| Immune Tolerance Network | |
| European Academy for Allergy and Clinical Immunology | |
| Allergy Therapeutics | |
| Federal Ministries of Technology, Economy and Technology, Food and Agriculture | |
| Rosetrees Trust | |
| Luxembourg National Research Fund | |
| National Institute of Allergy and Infectious Diseases | |
| Action Lions Vaincre le Cancer association | |
| Medical Research Council | MR/V049445/1, MC/PC/18052, MR/T032081/1, MR/R015643/1, MR/L023091/1, MR/M008517/1 |
| DFG | JA 1007/2–3 |
| European Union | PI22/01469, PI19/00710 |
| Swiss National Science Foundation | 101034170, 310030_207705 |
| Cancer Research UK | C30122/A11527, C30122/A15774 |
| FNRS‐Télévie | TLV 2023 RESTAGE |
| Biotechnology and Biological Sciences Research Council | BB/T008709/1 |
| British Skin Foundation | 006/R/22 |
| Breast Cancer Now | KCL‐BCN‐Q3 |
| Cancer Research UK King's Health Partners Centre at King's College London | C604/A25135 |
| Innovate UK | 463087 |
| Worldwide Cancer Research | 24‐0087 |
| European Regional Development Fund | RD21/0002/0008, RD24/0007/0024, PI21/00346 |
| Israel Science Foundation | 343/22 |
| Melanoma Special Fund | 573 |
| FNR | C24/BM/18858278, RC0004‐2021, PI18/00288 |
| BMBF | INDICATE‐FH |
| NIH | AUK‐BC‐2015‐01 |
| RICORS | RD21/0002/0058, RD24/0007/0010 |
Keywords
- AllergoOncology
- allergy
- basophil activation test (BAT)
- cancer immunotherapy
- hypersensitivity reactions
- precision medicine
