Positive Basophil Tests Are Linked to High Disease Activity and Other Features of Autoimmune Chronic Spontaneous Urticaria: A Systematic Review

Background: Chronic spontaneous urticaria (CSU) is believed to be Autoimmune (aiCSU) (type IIb CSU) in at least 8% of patients, associated with mast cell-activating IgG autoantibodies. Basophil tests such as the basophil activation test (BAT) and basophil histamine release assay (BHRA) are considered the best single tests for an aiCSU diagnosis. To date, the strength of associations among a positive BAT and/or BHRA (BAT/BHRA⁺) and CSU features, patient demographics, and response to treatment remains poorly characterized.

Objective: To evaluate the strength of current evidence on basophil tests as parameters for CSU characteristics.

Methods: We performed a systematic literature search and review to assess the relationship between BAT/BHRA⁺ and clinical and laboratory parameters of CSU. Of 1,058 records found in the search, 94 studies were reviewed by experts in urticaria and 42 were included in the analysis.

Results: In CSU patients, BAT/BHRA⁺ showed a strong level of evidence for an association with high disease activity and low levels of total IgE. A weak level of evidence was shown for the association of BAT/BHRA⁺ and the presence of angioedema, and basopenia.

Conclusions: Our results suggest that aiCSU defined by BAT/BHRA⁺ is more active or severe and is linked to other aiCSU markers such as low total IgE/basopenia. Basophil tests should be standardized and implemented in routine clinical care to improve the diagnosis and treatment of patients with aiCSU.