Abstract
Alpha-gal (AG) allergy is an IgE-mediated allergic reaction to galactose-alpha-1,3-galactose found in mammalian meat. Heparin, being derived from porcine intestinal tissue, may have a degree of cross-reactivity with AG antigen and thus place patients at risk for allergic and even anaphylactic reactions. This is especially important in patients with myocardial infarction (MI) and mechanical circulatory support, such as a left ventricular assist device (LVAD), since anticoagulation is immediately required. Therefore, individualized assessment and preoperative planning is needed regarding the use of heparin vs. nonheparinoid products in such a population.
Highlights
AG allergy, known as AG syndrome or red meat allergy, is an IgE-mediated allergic reaction to galactose-alpha-1,3galactose carbohydrate found in mammalian meat such as pork and beef
A 56-year-old male with a past medical history of coronary artery disease (status post percutaneous coronary intervention (PCI) to the distal left anterior descending artery (LAD) in 2011), ischemic cardiomyopathy, type 2 diabetes mellitus, hypertension, hyperlipidemia, and AG allergy presented with chest pain and dyspnea on exertion of one-day duration
This article describes a case of anterior wall ST segment elevation myocardial infarction (MI) leading to shock requiring inotrope therapy and eventually mechanical circulatory support
Summary
AG allergy, known as AG syndrome or red meat allergy, is an IgE-mediated allergic reaction to galactose-alpha-1,3galactose carbohydrate found in mammalian meat such as pork and beef. It usually occurs following a tick bite, with the lone star tick being the most predominant cause in the US [1]. Data on the degree of heparin cross-reactivity with AG antigen is still lacking, it is highly likely that such patients will react to heparin [4]. Intolerance to heparin products poses challenges for anticoagulation in patients with MI and postoperatively, in those with mechanical circulatory support devices such as LVAD
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