Abstract
Allergy to galactose-alpha-1,3-galactose (alpha-gal) presents as an immunoglobulin E (IgE)-mediated, yet delayed-onset hypersensitivity reaction to non-primate mammalian meat. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Alpha-gal sensitization develops after tick bite exposure. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar , 2 Commins S.P. James H.R. Kelly L.A. et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galacatose. J Allergy Clin Immunol. 2011; 127: 1286-1293 Abstract Full Text Full Text PDF PubMed Scopus (351) Google Scholar , 3 Fischer J. Lupberger E. Hebsaker J. et al. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters. Allergy. 2017; 72: 1540-1547 Crossref PubMed Scopus (59) Google Scholar The lone-star tick (Amblyomma americanum) represents the North American vector, spanning a relatively vast southeast, midwest, and northeast geographic distribution. 4 Approximate Distribution of the Lone Star Tick. Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Disease. Division of Vector-Borne Diseases. https://www.cdc.gov/ticks/maps/lone_star_tick.pdfDate accessed: March 28, 2019 Google Scholar Allergic manifestations include urticaria/angioedema, abdominal pain/diarrhea, or anaphylaxis, occurring approximately 3 to 6 hours after ingestion. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Alpha-gal hypersensitivity is not limited to food-related consumption. Other potential alpha-gal exposures include bioprosthetic heart valves and vaccines or medications (porcine/bovine origin or gelatin-containing), such as heparin. 5 Commins S.P. Invited commentary: Alpha-gal allergy: tip of the iceberg to a pivotal immune response. Curr Allergy Asthma Rep. 2016; 16: 61 Crossref PubMed Scopus (27) Google Scholar , 6 Dunkman W.J. Rycek W. Manning M.W. What does a red meat allergy have to do with anesthesia? Perioperative management of alpha-gal syndrome. Anesth Analg. 2018; https://doi.org/10.1213/ANE.0000000000003460 Crossref PubMed Scopus (8) Google Scholar , 7 Mozzicato S.M. Tripathi A. Posthumus J.B. Platts-Mills T.A.E. Commins S.P. Porcine or bovine valve replacement in 3 patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. J Allergy Clin Immunol Pract. 2014; 2: 637-638 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar
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