Allergy to Mammalian Meat Linked to Alpha-Gal Syndrome Potentially After Tick Bite in the Amazon: A Case Series.

Loïc Epelboin,Félix Djossou,Florent Roche,Maryvonne Dueymes,Olivier Duron,Angèle Soria,Geneviève Guillot,Mathieu Nacher

doi:10.4269/ajtmh.20-1630

Abstract

ABSTRACT.The past decade has seen the emergence of a new type of food allergy occurring after ingestion of mammalian meat. This allergy is related to immunoglobulin (Ig)E specific for galactose-alpha-1,3 galactose (α-Gal). Originally described in the United States in 2009, other cases have subsequently been described in Australia and in Europe, but still very few in Latin America. The purpose of this study was to show the existence of this pathology in French Guiana and to describe the historical, clinical, and biological characteristics of these patients. Patients reporting an allergy to mammalian meat were included between September 2017 and August 2019. Eleven patients were included, nine of whom exhibited digestive symptoms; four, urticaria reactions; three, respiratory reactions; and five angioedema. The time between ingestion of red meat and reaction varied between 1.5 and 6 hours. The implicated meats were most often beef and pork. All patients had been regularly exposed to tick bites before the appearance of symptoms. All the samples (n = 7) were positive for anti-α-Gal anti-mammalian meats IgE. All the patients were Caucasian French expatriates. This study confirms the presence of this new entity in French Guiana and is the largest reported in Latin America. Our results do 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.

Highlights

The past decade has seen the emergence of a new type of food allergy characterized by various, sometimes severe, reactions after ingestion of mammalian meat
The past decade has seen the emergence of a new type of food allergy occurring after ingestion of mammalian meat
This study confirms the presence of this new entity in French Guiana and is the largest reported in Latin America

Summary

Introduction

The past decade has seen the emergence of a new type of food allergy characterized by various, sometimes severe (anaphylactic shock), reactions after ingestion of mammalian meat. This oligosaccharide was identified in patients treated with cetuximab in the United States, a chimeric monoclonal antibody directed against the epidermal growth factor receptor, which is used in the treatment of colorectal cancers or squamous cell cancers of the head and of the neck.[1] In the 2000s, several patients developed immediate hypersensitivity reactions, sometimes severe The prevalence of these reactions was more than 20 times greater in the southeastern regions of the United States compared with the northeastern regions.[1,2] These patients presented hypersensitivity reactions during the first cetuximab infusion.

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