Abstract
Alpha-gal allergy, also known as, mammalian meat allergy (MMA) is well described in the Allergy literature, however, the Anesthesiology literature remains soft in supporting recommendations for perioperative management. The goal of the Centers for Disease Control and Prevention (CDC) is to better understand the pathogenesis, signs and symptoms, and prevention of this delayed anaphylactic reaction compared to the rapid onset of most food allergies, especially immunoglobulin E (IgE) mediated allergy. MMA is not limited to dietary beef, bison, goat, pork, lamb, and venison intake alone but includes some perioperative medication formularies containing inactive ingredients such as gelatin, glycerin or stearate; surgical products such as surgical powder, xenografts, and porcine derived heart valve per the manufacturer's specifications.
Highlights
Delayed anaphylaxis to mammalian meat in patients with immunoglobulin E (IgE) antibodies specific for galactose-alpha-1,3-galactose has been described by Commins and Platts-Mills [1,2]
Amblyomma americanum known as Lone star tick, Northeastern water tick, turkey tick in the eastern United States, and Mexico Ixodes holocyclus aka Paralysis tick Australian species Ixodes ricinus aka Castor bean tick European species Other existing unknown vectors Anaphylaxis, angioedema, urticaria, gastrointestinal disturbance Young age, suggestive of other unknown ways of sensitization Assay measuring IgE specific to alpha-gal (Viracor-IBT Labs) Skin test, Basophil activation test with cetuximab > meats Delayed life-threatening symptoms: epinephrine, steroids, H-2 blockers None Unconfirmed recovery potential
Kennedy JL, et al determined from clinics or offices in the state of Virginia IgE antibodies to alpha-gal were present in the serum of pediatric patients having a history of delayed anaphylaxis or urticaria to mammalian meat with most cases having a history of tick bites within the past year [12]
Summary
Delayed anaphylaxis to mammalian meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose (alpha-gal) has been described by Commins and Platts-Mills [1,2]. When compared to Tennessee and North Carolina severe hypersensitivity reactions were reported to be 22% in patients treated with cetuximab [4]. Results in Virginia, North Carolina, and Tennessee revealed that as many as 20% of the population in these states have serum IgE antibodies to alpha-gal This strongly suggested tick bites as a cause of IgE antibody responses to alpha-gal in the southeastern United States [6]. The tick vector is capable of injecting alpha-gal into a human, triggering an immune response of IgE antibodies against the foreign carbohydrate. Since serological conversion to alpha-gal takes several months symptoms may be delayed for three to six months after the tick bite
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