Food allergy to the carbohydrate galactose-alpha-1,3-galactose (alpha-gal): four case reports and a review

@article{Bircher2017FoodAT,
  title={Food allergy to the carbohydrate galactose-alpha-1,3-galactose (alpha-gal): four case reports and a review},
  author={Andreas J. Bircher and Kathrin Scherer Hofmeier and Susanne Link and Ingmar A.F.M. Heijnen},
  journal={European Journal of Dermatology},
  year={2017},
  volume={27},
  pages={3-9}
}
Until recently, food allergies to mammalian meats have been considered to be very rare. The observation that patients not previously exposed to the monoclonal chimeric antibody cetuximab suffered from severe anaphylaxis upon first exposure, led to the identification of galactosealpha- 1,3-galactose as a new relevant carbohydrate allergen. These patients later often suffered from anaphylactic reactions to red meat. Epidemiological data indicated that bites by the tick Amblyomma americanum in the… 
Allergy to Mammalian Meat Linked to Alpha-Gal Syndrome Potentially After Tick Bite in the Amazon: A Case Series
TLDR
The presence of this new entity in French Guiana is confirmed and is the largest reported in Latin America and does not clearly allow us to state that tick bites are the cause of this allergy, but all patients reported being exposed regularly to these arthropods.
Galactose-α-1,3-galactose Allergy Induced by Amblyomma americanum: A Review and Introduction of Experimental Designs
TLDR
Research is to be conducted in the Liberty University labs to investigate how the lone star tick causes sensitization to thealpha-gal antigen, and to aid in discovering a treatment for, or prevention of, the alpha-gal allergy.
Alpha‐gal syndrome: An emerging cause of food and drug allergy
TLDR
This review summarises recent advances in the understanding of α‐gal syndrome, its clinical presentation, pathomechanism and role of various tick species in the development of AGS.
Clinical and serological characterization of the α-Gal syndrome - importance of atopy for symptom severity in a European cohort.
TLDR
Atopy was found to affect the manifestation of the disease in Swedish patients, and α-Gal IgE levels were significantly higher among these patients compared to those without anaphylaxis.
Environmental and Molecular Drivers of the α-Gal Syndrome
TLDR
Blood group antigens influence the capacity of the immune system to produce anti-α-Gal Abs which in turn impacts individual susceptibility to AGS, and the link between blood groups and anti- α-Gal immunity, suggests a trade-off between susceptibility toAGS and protection to some infectious diseases.
What Does a Red Meat Allergy Have to Do With Anesthesia? Perioperative Management of Alpha-Gal Syndrome.
TLDR
This allergy presents a number of unique challenges to the anesthesiologist, including proper identification of a patient with alpha-gal syndrome and selection of anesthetic and adjunctive medications that will not trigger this allergy.
Red meat desensitization in a child with delayed anaphylaxis due to alpha‐Gal allergy
TLDR
There are limited number of cases with alpha-Gal allergy in children, and severe delayed onset systemic reactions within 2-6 hours of exposure to red meat may be presented as symptoms of urticaria-angioedema and life-threatening anaphylaxis in alpha- Gal allergy.
Tick Saliva and the Alpha-Gal Syndrome: Finding a Needle in a Haystack
TLDR
The underlying immune mechanisms linking tick bites with α-gal-specific IgE production are poorly understood and are crucial to identify and establish novel treatments for Alpha-gal syndrome.
The alpha-Gal syndrome: new insights into the tick-host conflict and cooperation
TLDR
This primer focuses on a recently diagnosed tick-borne allergic disease known as the alpha-Gal syndrome, where high levels of IgE antibodies against the carbohydrate Galα1-3Galβ1-(3)4GlcNAc-R (α-Gal) present on tick salivary glycoproteins and tissues of non-catarrhine mammals lead to the AGS in some individuals.
Recurring acute urticaria and abdominal pain: Consider a diagnosis of alpha-galactose anaphylaxis.
TLDR
A 60-year-old woman presenting four episodes of acute urticaria with signs of anaphylaxis occurring a few hours after meals containing mammalian meat is reported, and allergy to α-galactose should be considered.
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TLDR
Evidence is provided that tick bites are a cause, possibly the only cause, of IgE specific for alpha-gal in this area of the United States, and the first example of a response to an ectoparasite giving rise to an important form of food allergy is reported.
Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose.
TLDR
A novel and severe food allergy related to IgE antibodies to the carbohydrate epitope alpha-gal is reported from patients who experience delayed symptoms of anaphylaxis, angioedema, or urticaria associated with eating beef, pork, or lamb.
Galactose-α-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children
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A novel form of anaphylaxis and urticaria that occurs 3 to 6 hours after eating mammalian meat is not uncommon among children in this area and should certainly be considered for children living in the area where the Lone Star tick is common.
Galactose-α-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma.
TLDR
These results provide a model of an ectoparasite-induced specific IgE response that can increase total serum IgE without creating a risk for asthma, and further evidence that the main allergens that are causally related to asthma are those that are inhaled.
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TLDR
In patients with delayed immediate-type allergy to innards and red meat, consuming red meat and especially innards can lead to the development of immediate type reactions such as urticaria, Cetuximab is a humanized IgG1 antibody containing murine α-Gal, and allergic reactions may occur with its first administration.
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TLDR
A strong correlation was observed, supporting the association between tick bites and sensitization to α-Gal, among patients presenting with allergic reactions from the southeastern United States.
Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose.
TLDR
It is reported that in vivo basophil activation during a food challenge occurs in the same time frame as clinical symptoms and likely reflects the appearance of the antigen in the bloodstream.
Clinical spectrum of α-Gal syndrome: from immediate-type to delayed immediate-type reactions to mammalian innards and meat
TLDR
Clinical observations and challenge testing in this constellation reveal that individual sensitivity in α-Gal patients is highly variable and which broadens the basic understanding of α- Gal syndrome.
Impaired allergy diagnostics among parasite-infected patients caused by IgE antibodies to the carbohydrate epitope galactose-α 1,3-galactose.
TLDR
IgE to α-Gal causes impaired allergy diagnostics in parasite-infected patients and screening for IgE to rFel d 1 and other allergens without carbohydrates might identify patients with true cat sensitization/allergy in parasites-infested areas.
Safe administration of a gelatin-containing vaccine in an adult with galactose-α-1,3-galactose allergy.
TLDR
A patient with α-Gal allergy who successfully tolerated the live zoster vaccine is described and continued safety assessment of gelatin-containing vaccines for this patient cohort is recommended as there are multiple factors for this patients cohort that influence the reaction risk.
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