{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:29:39Z","timestamp":1788791379879,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Approximately 15% of the population in developed countries report a penicillin allergy in their medical history. However, this changes considerably following a comprehensive allergological evaluation. Numerous studies have shown that a true penicillin allergy is confirmed in only about 8% of individuals. Recommended diagnostic protocols are usually complex and time-consuming, as they rely primarily on in vivo diagnostic approaches, such as skin testing and drug provocation tests. To date, there are no clear guidelines regarding the implementation of in vitro tests in diagnostic algorithms for patients with suspected penicillin allergies. Currently available in vitro methods are characterized by limited sensitivity and specificity. On the other hand, they offer the potential to reduce the need for drug provocation testing, which remains the gold standard but carries an inherent risk of inducing clinical reactions. Consequently, researchers continue to explore methodological improvements aimed at enhancing the diagnostic performance and clinical utility of these tests. In this systematic review, we analyze the current possibilities and limitations of the basophil activation test (BAT) and the measurement of specific IgE (sIgE) antibodies, as well as their potential role in the routine diagnostic workup of patients with suspected immediate hypersensitivity reactions to penicillins.<\/jats:p>","DOI":"10.3390\/ijms27177960","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:53:28Z","timestamp":1788789208000},"page":"7960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Are Basophil Activation Test (BAT) and IgE Levels Useful Tools in Confirming Penicillin Allergy? Novel Diagnostic Approach in Beta-Lactams Hypersensitivity Reactions: A Systematic Review"],"prefix":"10.3390","volume":"27","author":[{"given":"Bernadetta","family":"Kosztulska","sequence":"first","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Rydzy\u0144ska","sequence":"additional","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Grze\u015bk-Kaczy\u0144ska","sequence":"additional","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5606-0529","authenticated-orcid":false,"given":"Tomasz","family":"Rosada","sequence":"additional","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Ku\u017ami\u0144ski","sequence":"additional","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5957-8382","authenticated-orcid":false,"given":"Natalia","family":"Ukleja-Soko\u0142owska","sequence":"additional","affiliation":[{"name":"Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1111\/all.16567","article-title":"Direct Single-Dose Drug-Provocation Test Is Safe for Delabelling Penicillin Low-Risk Reactions in Adults","volume":"80","author":"Labella","year":"2025","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1111\/all.14122","article-title":"Towards a more precise diagnosis of hypersensitivity to beta-lactams\u2014An EAACI position paper","volume":"75","author":"Romano","year":"2020","journal-title":"Allergy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/j.1398-9995.2008.01713.x","article-title":"Negativization rates of IgE radioimmunoassay and basophil activation test in immediate reactions to penicillins","volume":"64","author":"Torres","year":"2009","journal-title":"Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S0140-6736(18)32218-9","article-title":"Antibiotic allergy","volume":"393","author":"Blumenthal","year":"2019","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1001\/jamainternmed.2020.0403","article-title":"Development and validation of a penicillin allergy clinical decision rule","volume":"180","author":"Trubiano","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100719","DOI":"10.1016\/j.jacig.2026.100719","article-title":"Evaluating penicillin allergy clinical decision-making tools to enhance penicillin allergy delabeling","volume":"5","author":"Su","year":"2026","journal-title":"J. Allergy Clin. Immunol. Glob."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/all.15970","article-title":"Changing patterns in the epidemiology of drug allergy","volume":"79","author":"Torres","year":"2024","journal-title":"Allergy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.anai.2022.09.011","article-title":"Beta-lactam hypersensitivity diagnosis in ambulatory and hospitalized settings require different approaches","volume":"130","author":"Chongpison","year":"2023","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/pai.12155","article-title":"Diagnostic evaluation of hypersensitivity reactions to beta-lactam antibiotics in a large population of children","volume":"25","author":"Zambonino","year":"2014","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13756-023-01232-0","article-title":"An interdisciplinary student-led multifaceted intervention addressing overuse of broad-spectrum antibiotics for patients with penicillin allergies","volume":"12","author":"Banashefski","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jaci.2013.09.021","article-title":"Health care use and serious infection prevalence associated with penicillin \u201callergy\u201d in hospitalized patients: A cohort study","volume":"133","author":"Macy","year":"2013","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1111\/cea.70061","article-title":"Assessment of Patients with Beta-Lactams Positive Provocation Tests by Biomarkers of IgG-Related Neutrophil Activation","volume":"55","author":"Gallizzi","year":"2025","journal-title":"Clin. Exp. Allergy"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kosztulska, B., Rydzy\u0144ska, M., Bartuzi, Z., Grze\u015bk-Kaczy\u0144ska, M., and Ukleja-Soko\u0142owska, N. (2025). The Expanding Role of Omalizumab: From Food Allergy to Drug Desensitization. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26167868"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2885","DOI":"10.1111\/all.70222","article-title":"Development of Betalactam-Predictor: A Clinical Decision Tool for Delabeling Low-Risk Betalactam Allergy Patients. Initial Validation in Penicillin Allergy","volume":"81","author":"Labella","year":"2026","journal-title":"Allergy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.jaci.2020.04.058","article-title":"Accuracy of penicillin allergy diagnostic tests: A systematic review and meta-analysis","volume":"147","author":"Tarrio","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.jaip.2023.11.004","article-title":"Performance Characteristics of Basophil Activation Tests for Diagnosing Penicillin Allergy: A Meta-Analysis","volume":"12","author":"Bennett","year":"2024","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100640","DOI":"10.1016\/j.waojou.2022.100640","article-title":"Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement","volume":"15","author":"Broyles","year":"2022","journal-title":"World Allergy Organ. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"14608","DOI":"10.1021\/acs.analchem.0c03020","article-title":"Multiparametric Highly Sensitive Chemiluminescence Immunoassay for Quantification of \u03b2-Lactam-Specific Immunoglobulin E","volume":"92","author":"Morais","year":"2020","journal-title":"Anal. Chem."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"12113","DOI":"10.1021\/acs.analchem.3c02284","article-title":"Standardizing In Vitro \u03b2-Lactam Antibiotic Allergy Testing with Synthetic IgE","volume":"95","author":"Maquieira","year":"2023","journal-title":"Anal. Chem."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kosztulska, B., Grze\u015bk-Kaczy\u0144ska, M., Rydzy\u0144ska, M., Bartuzi, Z., and Ukleja-Soko\u0142owska, N. (2025). Basophil Activation Test (BAT) for Diagnosing LTP Food Allergy: Where Do We Stand Now? A Systematic Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110401"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/j.1365-2222.2009.03426.x","article-title":"A new basophil activation test using CD63 and CCR3 in allergy to antibiotics","volume":"40","author":"Eberlein","year":"2010","journal-title":"Clin. Exp. Allergy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.aller.2020.01.006","article-title":"Minimal agreement between basophil activation test and immunoassay in diagnosis of penicillin allergy","volume":"48","author":"Leecyous","year":"2020","journal-title":"Allergol. Immunopathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1001\/jama.2017.6510","article-title":"Penicillin Allergy Is Not Necessarily Forever","volume":"318","author":"Trubiano","year":"2017","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.jaip.2024.12.043","article-title":"Resensitization-Should Repeat Testing Be Performed in Patients Undergoing Penicillin Allergy Evaluations? A Pro-Con Debate","volume":"13","author":"Belmont","year":"2025","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/S0091-6749(99)70439-2","article-title":"Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics","volume":"103","author":"Blanca","year":"1999","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_27","unstructured":"(2025, September 05). PRISMA 2020 Checklist. Available online: https:\/\/www.prisma-statement.org\/."},{"key":"ref_28","first-page":"741","article-title":"Comparing Basophil Activation Test and Specific IgE Assay in the Diagnosis of Allergy to Penicillin G and Ibuprofen","volume":"24","author":"Shakerin","year":"2025","journal-title":"Iran. J. Allergy Asthma Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1111\/all.15610","article-title":"Diagnosis of immediate reactions to amoxicillin: Comparison of basophil activation markers CD63 and CD203c in a prospective study","volume":"78","author":"Ariza","year":"2023","journal-title":"Allergy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jaip.2022.10.050","article-title":"Basophil Activation Test Shows Poor Sensitivity in Immediate Amoxicillin Allergy","volume":"11","author":"Heremans","year":"2023","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"200","DOI":"10.2500\/aap.2023.44.230013","article-title":"Diagnostic utility of basophil CD203c expression in \u03b2-lactam allergy","volume":"44","author":"Celik","year":"2023","journal-title":"Allergy Asthma Proc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1111\/all.16133","article-title":"Lipopolysaccharides in combination with amoxicillin increases basophil activation test sensitivity to amoxicillin IgE-mediated hypersensitivity","volume":"79","author":"Bogas","year":"2024","journal-title":"Allergy"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Reitmajer, M., Strauss, A., Klinger, C., Maau, M., Kempf, W.E., Fischer, J., Kneilling, M., and Volc, S. (2024). Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics. Front. Allergy, 5.","DOI":"10.3389\/falgy.2024.1512875"},{"key":"ref_34","first-page":"303","article-title":"Clinical Relevance of Specific IgE in Penicillin Allergy Investigation","volume":"186","author":"Lendal","year":"2025","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100041","DOI":"10.1016\/j.mbm.2024.100041","article-title":"Mechanobiology of Type 1 hypersensitivity: Elucidating the impacts of mechanical forces in allergic reactions","volume":"2","author":"Sutanto","year":"2024","journal-title":"Mechanobiol. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"35113","DOI":"10.1038\/srep35113","article-title":"The influence of the carrier molecule on amoxicillin recognition by specific IgE in patients with immediate hypersensitivity reactions to betalactams","volume":"6","author":"Ariza","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1084\/jem.114.6.875","article-title":"Studies on the mechanism of the formation of the penicillin antigen. III. The N-(D-alpha-benzylpenicilloyl) group as an antigenic determinant responsible for hypersensitivity to penicillin G","volume":"114","author":"Levine","year":"1961","journal-title":"J. Exp. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ariza, A., Collado, D., Vida, Y., Monta\u00f1ez, M.I., P\u00e9rez-Inestrosa, E., Blanca, M., Torres, M.J., Ca\u00f1ada, F.J., and P\u00e9rez-Sala, D. (2014). Study of protein haptenation by amoxicillin through the use of a biotinylated antibiotic. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0090891"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jaci.2009.11.032","article-title":"Clavulanic acid can be the component in amoxicillin-clavulanic acid responsible for immediate hypersensitivity reactions","volume":"125","author":"Torres","year":"2010","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_40","first-page":"12","article-title":"Hypersensitivity reactions to \u03b2-lactams: Relevance of hapten-protein conjugates","volume":"25","author":"Ariza","year":"2015","journal-title":"J. Investig. Allergol. Clin. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Izmailovich, M., Kabyldina, A., Seilkhan, Z., Zhussip, A., Kozhanova, R., Nurpeissov, T., Uteubaeva, G., Kazimirova, O., Lavrinenko, A., and Brizitskaya, L. (2026). The Basophil Activation Test in Allergy Diagnostics: Clinical Applications, Methodological Challenges, and Proposed Clinical Frameworks. Cells, 15.","DOI":"10.3390\/cells15141241"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"P32","DOI":"10.1186\/2045-7022-4-S3-P32","article-title":"Inclusion of clavulanic acid determinants in the basophil activation test improves the evaluation of immediate reactions to amoxicillin-clavulanic acid","volume":"4","author":"Fernandez","year":"2014","journal-title":"Clin. Transl. Allergy"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Vaali, K., Ekumi, K.M., Andersson, M.A., Mannerstr\u00f6m, M., and Heinonen, T. (2023). In Search of Clinical Markers: Indicators of Exposure in Dampness and Mold Hypersensitivity Syndrome (DMHS). J. Fungi, 9.","DOI":"10.3390\/jof9030332"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4584","DOI":"10.4049\/jimmunol.178.7.4584","article-title":"Histamine release from the basophils of control and asthmatic subjects and a comparison of gene expression between \u201creleaser\u201d and \u201cnonreleaser\u201d basophils","volume":"178","author":"Youssef","year":"2007","journal-title":"J. Immunol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Balsells-Vives, S., San Bartolom\u00e9, C., Casas-Saucedo, R., Ruano-Zaragoza, M., Rius, J., Torradeflot, M., Bartra, J., Munoz-Cano, R., and Pascal, M. (2022). Low Levels Matter: Clinical Relevance of Low Pru p 3 sIgE in Patients With Peach Allergy. Front. Allergy, 3.","DOI":"10.3389\/falgy.2022.868267"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.ajhg.2020.08.008","article-title":"Genome-wide Study Identifies Association between HLA-B* 55:01 and Self-Reported Penicillin Allergy","volume":"107","author":"Krebs","year":"2020","journal-title":"Am. J. Hum. Genet."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"111943","DOI":"10.1016\/j.forsciint.2024.111943","article-title":"DNA methylation profiling reveals potential biomarkers of \u03b2-lactams induced fatal anaphylactic shock","volume":"356","author":"Guo","year":"2024","journal-title":"Forensic Sci. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1111\/all.16607","article-title":"Basophil Activation Test: Bridging Allergy and Oncology for Diagnostic, Therapeutic and Prognostic Applications in AllergoOncology: An EAACI Position Paper","volume":"80","author":"Pascal","year":"2025","journal-title":"Allergy"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.jaip.2017.08.009","article-title":"Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy","volume":"6","author":"Salas","year":"2018","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.1111\/all.15902","article-title":"EAACI guidelines on the diagnosis of IgE-mediated food allergy","volume":"78","author":"Santos","year":"2023","journal-title":"Allergy"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"14160","DOI":"10.1038\/s41598-020-71083-x","article-title":"Penicillin causes non-allergic anaphylaxis by activating the contact system","volume":"10","author":"Gao","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"113050","DOI":"10.1016\/j.jim.2021.113050","article-title":"Basophil and mast cell activation tests by flow cytometry in immediate drug hypersensitivity: Diagnosis and beyond","volume":"495","author":"Elst","year":"2021","journal-title":"J. Immunol. Methods"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1001\/jamapediatrics.2020.0944","article-title":"Allergen Specificity in Specific IgE Cutoff","volume":"174","author":"Schoos","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"3183","DOI":"10.1111\/all.14834","article-title":"Nanoarchitectures for efficient IgE cross-linking on effector cells to study amoxicillin allergy","volume":"76","author":"Tesfaye","year":"2021","journal-title":"Allergy"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Gil-Oca\u00f1a, V., Jimenez, I.M., Mayorga, C., Do\u00f1a, I., C\u00e9spedes, J.A., Monta\u00f1ez, M.I., Vida, Y., Torres, M.J., and Perez-Inestrosa, E. (2021). Multiepitope Dendrimeric Antigen-Silica Particle Composites as Nano-Based Platforms for Specific Recognition of IgEs. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.750109"},{"key":"ref_56","first-page":"773","article-title":"Regulation of mast-cell and basophil function and survival by IgE","volume":"2","author":"Kawakami","year":"2002","journal-title":"Nat. Rev."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/17\/7960\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:59:54Z","timestamp":1788789594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/17\/7960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":56,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["ijms27177960"],"URL":"https:\/\/doi.org\/10.3390\/ijms27177960","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}