The Basophil Activation Test Is the Most Accurate Test in Predicting Allergic Reactions to Baked and Fresh Cow's Milk During Oral Food Challenges

Irene Bartha; Holly Boyd; Ru‐Xin Foong; Marta Krawiec; Andreina Marques‐Mejias; Hannah F. Marshall; Suzana Radulovic; Faye Harrison; Grammatiki Antoneria; Zainab Jama; Matthew Kwok; Ewa Pietraszewicz; Malak Eghleilib; Cristian Ricci; Tom Marrs; Gideon Lack; George Du Toit; Alexandra F. Santos

doi:10.1111/all.16675

journal article Open Access Aug 13, 2025

The Basophil Activation Test Is the Most Accurate Test in Predicting Allergic Reactions to Baked and Fresh Cow's Milk During Oral Food Challenges

Irene Bartha

Holly Boyd Ru‐Xin Foong

Marta Krawiec Andreina Marques‐Mejias Hannah F. Marshall

Suzana Radulovic Faye Harrison Grammatiki Antoneria Zainab Jama Matthew Kwok Ewa Pietraszewicz Malak Eghleilib Cristian Ricci

Tom Marrs Gideon Lack

George Du Toit

Alexandra F. Santos

Allergy Vol. 80 No. 10 pp. 2861-2873 · Wiley

View at Publisher Save 10.1111/all.16675

Abstract

ABSTRACTBackgroundCow's milk is the most common cause of food allergy and related fatalities. Consumption of baked milk (BM) has been associated with better prognosis, nutrition and quality‐of‐life.MethodsThe BAT 2 milk study (NCT03309488) was a diagnostic study of cow's milk allergy designed according to STARD guidelines. All children had an oral food challenge (OFC) to BM, and those who tolerated BM were offered an OFC to fresh milk (FM). The diagnostic performance of the basophil activation test (BAT), skin prick test (SPT) and specific IgE (sIgE) was assessed in comparison with OFC.ResultsOut of the 150 children studied, 85% tolerated BM and 56% also tolerated FM. BAT had the best diagnostic accuracy (area under the receiver operator characteristic curve 0.90 for BM and 0.81 for FM) compared with the other tests for both BM (sIgE: 0.79 and SPT: 0.70) and FM (sIgE: 0.74 and SPT: 0.78) allergies. Using 100% sensitivity and 100% specificity cut‐offs to select patients for OFC would have led to the following proportion of children having OFC (and positive OFC) to BM: 99% (13%) for SPT to baked milk, 82% (17%) for sIgE to boiled milk, and 49% (24%) for BAT to baked milk. In children younger than 2 years, only 27% required an OFC following BAT to BM (compared to 100% and 81% following SPT or sIgE to milk extract, respectively), with 100% diagnostic accuracy.ConclusionsBAT was the best test to identify children who reacted on OFC to BM or FM. Using 100% sensitivity and 100% specificity cut‐offs, BAT ensured the lowest need for OFC and 100% diagnostic accuracy.Trial Registrationclinicaltrials.gov identifier: NCT03309488

Topics

No keywords indexed for this article. Browse by subject →

References

28

[1]

10.1111/all.15801

[2]

10.1016/j.jaip.2024.08.006

[3]

10.1136/bmj.n251

[4]

10.1016/s2468‐2667(24)00163‐4

[5]

10.1016/j.jaci.2021.03.048

[6]

The natural history of milk allergy in an observational cohort

Robert A. Wood, Scott H. Sicherer, Brian P. Vickery et al.

Journal of Allergy and Clinical Immunology 10.1016/j.jaci.2012.10.060

[7]

10.1111/all.16330

[8]

10.1111/all.15939

[9]

10.1016/j.jaci.2024.12.1071

[10]

10.1111/all.15902

[11]

10.1136/bmjopen‐2016‐012799

[12]

10.1111/all.15797

[13]

10.1111/pai.13870

[14]

10.1016/j.jaci.2012.10.017

[15]

10.1016/j.jaci.2014.04.039

[16]

10.1016/j.jaci.2008.05.043

[17]

10.1016/j.jaci.2020.03.035

[18]

10.1056/nejmoa1414850

[19]

10.1016/j.jaci.2015.12.1322

[20]

10.1016/j.jaci.2012.06.003

[21]

10.1111/cea.13307

[22]

10.1159/000312126

[23]

10.1186/2047‐783x‐15‐s2‐21

[24]

10.1016/j.jaci.2020.05.040

[25]

10.1111/all.16451

[26]

10.1016/j.jaci.2023.08.032

[27]

10.1056/evidoa2300145

[28]

10.1016/j.jaip.2023.12.036

Metrics

4

Citations

28

References

Details

Published: Aug 13, 2025
Vol/Issue: 80(10)
Pages: 2861-2873
License: View

Authors

I

Irene Bartha

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

H

Holly Boyd

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

R

Ru‐Xin Foong

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

M

Marta Krawiec

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

A

Andreina Marques‐Mejias

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

H

Hannah F. Marshall

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

S

Suzana Radulovic

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

F

Faye Harrison

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

G

Grammatiki Antoneria

Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

Z

Zainab Jama

Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

M

Matthew Kwok

Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

E

Ewa Pietraszewicz

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

M

Malak Eghleilib

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

C

Cristian Ricci

Africa Unit for Transdisciplinary Health Research (AUTHeR) North‐West University Potchefstroom South Africa

T

Tom Marrs

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

G

Gideon Lack

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

G

George Du Toit

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK

A

Alexandra F. Santos

Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London London UK; Children's Allergy Service, Evelina London Children's Hospital Guy's and St Thomas' Hospital London UK; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences King's College London London UK

Funding

Medical Research Council

Cite This Article

Irene Bartha, Holly Boyd, Ru‐Xin Foong, et al. (2025). The Basophil Activation Test Is the Most Accurate Test in Predicting Allergic Reactions to Baked and Fresh Cow's Milk During Oral Food Challenges. Allergy, 80(10), 2861-2873. https://doi.org/10.1111/all.16675

The Basophil Activation Test Is the Most Accurate Test in Predicting Allergic Reactions to Baked and Fresh Cow's Milk During Oral Food Challenges

You May Also Like