BACKGROUND-Cetuximab, a chimeric mouse-human IgG1 monoclonal antibody against the epidermal growth factor receptor, is approved for use in colorectal cancer and squamous-cell carcinoma of the head and neck. A high prevalence of hypersensitivity reactions to cetuximab has been reported in some areas of the United States.

Background Carbohydrate moieties are frequently encountered in food and can elicit IgE responses, the clinical significance of which has been unclear. Recent work, however, has shown that IgE antibodies to galactose-α-1,3-galactose (α-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, are capable of eliciting serious, even fatal, reactions. Objective We sought to determine whether IgE antibodies to α-gal are present in sera from patients who report anaphylaxis or urticaria after eating beef, pork, or lamb. Methods Detailed histories were taken from patients presenting to the University of Virginia Allergy Clinic. Skin prick tests (SPTs), intradermal skin tests, and serum IgE antibody analysis were performed for common indoor, outdoor, and food allergens. Results Twenty-four patients with IgE antibodies to α-gal were identified. These patients described a similar history of anaphylaxis or urticaria 3 to 6 hours after the ingestion of meat and reported fewer or no episodes when following an avoidance diet. SPTs to mammalian meat produced wheals of usually less than 4 mm, whereas intradermal or fresh-food SPTs provided larger and more consistent wheal responses. CAP-RAST testing revealed specific IgE antibodies to beef, pork, lamb, cow’s milk, cat, and dog but not turkey, chicken, or fish. Absorption experiments indicated that this pattern of sensitivity was explained by an IgE antibody specific for α-gal. Conclusion We report a novel and severe food allergy related to IgE antibodies to the carbohydrate epitope α-gal. These patients experience delayed symptoms of anaphylaxis, angioedema, or urticaria associated with eating beef, pork, or lamb.

Landscape urbanization broadly alters watersheds and stream ecosystems, yet the impact of nonpoint source urban inputs on the quantity, quality, and ultimate fate of dissolved organic matter (DOM) is poorly understood. We assessed DOM quality and microbial bioavailability in eight first-order Coastal Plain headwater streams along a gradient of urbanization (i.e., percent watershed impervious cover); none of the streams had point source discharges. DOM quality was measured using fluorescence excitation-emission matrices (EEMs) coupled with parallel factor analysis (PARAFAC). Bioavailability was assessed using biodegradable dissolved organic carbon (BDOC) incubations. Results showed that watershed impervious cover was significantly related to stream DOM composition: increasing impervious cover was associated with decreased amounts of natural humic-like DOM and enriched amounts of anthropogenic fulvic acid-like and protein-like DOM. Microbial bioavailability of DOM was greater in urbanized streams during spring and summer, and was related to decreasing proportions of humic-like DOM and increasing proportions of protein-like DOM. Increased bioavailability was associated with elevated extracellular enzyme activity of the initial microbial community supplied to samples during BDOC incubations. These findings indicate that changes in stream DOM quality due to watershed urbanization may impact stream ecosystem metabolism and ultimately the fate of organic carbon transported through fluvial systems.

River networks modify material transfer from land to ocean. Understanding the factors regulating this function for different gaseous, dissolved, and particulate constituents is critical to quantify the local and global effects of climate and land use change. We propose the River Network Saturation (RNS) concept as a generalization of how river network regulation of material fluxes declines with increasing flows due to imbalances between supply and demand at network scales. River networks have a tendency to become saturated (supply) demand) under higher flow conditions because supplies increase faster than sink processes. However, the flow thresholds under which saturation occurs depends on a variety of factors, including the inherent process rate for a given constituent and the abundance of lentic waters such as lakes, ponds, reservoirs, and fluvial wetlands within the river network. As supply increases, saturation at network scales is initially limited by previously unmet demand in downstream aquatic ecosystems. The RNS concept describes a general tendency of river network function that can be