Cross‐reactivity between tick and wasp venom can contribute to frequent wasp sensitization in patients with the α‐Gal syndrome

Kiewiet, Mensiena B. G.; Peruško, Marija; Grundström, Jeanette; Hamsten, Carl; Starkhammar, Maria; Apostolović, Danijela; Hage, Marianne van

doi:10.1002/clt2.12113

Cited by 9 publications

(7 citation statements)

References 40 publications

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“…Secondly, molecular similarities between tick and wasp proteins can lead to cross‐reactivity. However, it has not been clearly studied so far 47 . In our study, RMA was accompanied by venom allergy in five (25%) patients similar to our previous report 41 .…”

Section: Discussionsupporting

confidence: 89%

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Oral immunotherapy in alpha‐gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

Ünal,

Eyice‐Karabacak,

Kutlu

et al. 2023

Allergy

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BackgroundOral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long‐term safety and efficacy of a novel red meat (RM) OIT in galactose‐alpha‐1,3‐galactose (alpha‐gal) allergy in adults.MethodsOut of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early‐onset and delayed‐onset alpha‐gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha‐gal specific Immunoglobulin‐E (sIgE) in the first and fifth years.ResultsAll patients who underwent OIT became tolerant to RM. During the 5 year follow‐up, the median alpha‐gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p = .016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha‐gal sIgE concentrations whereas one patient with low follow‐up alpha‐gal sIgE concentrations consumed RM uneventfully after frequent tick bites.ConclusionsOur study showed the long‐term safety and efficacy of alpha‐gal OIT. Additionally, alpha‐gal sIgE seems to be a potential biomarker to monitor OIT.

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Section: Discussionsupporting

confidence: 89%

“…However, it has not been clearly studied so far. 47 In our study, RMA was accompanied by venom allergy in five (25%) patients similar to our previous report. 41 Although 80-90% of patients with alpha-gal allergy do not react to milk or cheese, some patients may have gastrointestinal symptoms and urticaria due to dairy product allergy.…”

Section: Clinical Outcomessupporting

confidence: 91%

Oral immunotherapy in alpha‐gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

Ünal,

Eyice‐Karabacak,

Kutlu

et al. 2023

Allergy

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“…More than 50% of our AGS patients were sensitized to wasp, however the IgE levels to wasp were low. We noted that wasp sensitization mainly occurred among AGS patients with higher IgE levels to α‐Gal and was probably due to cross-reactivity between wasp and tick proteins ( 75 ). Positive associations between sensitization to α-Gal and bee and wasp venom were also found in an AGS cohort from the US ( 34 ).…”

Section: Association Of Ags With Tick Bitesmentioning

confidence: 99%

The α-Gal epitope - the cause of a global allergic disease

Perusko,

Grundström,

Eldh

et al. 2024

Front. Immunol.

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The galactose-α-1,3-galactose (α-Gal) epitope is the cause of a global allergic disease, the α-Gal syndrome (AGS). It is a severe form of allergy to food and products of mammalian origin where IgE against the mammalian carbohydrate, α-Gal, is the cause of the allergic reactions. Allergic reactions triggered by parenterally administered α-Gal sources appear immediately, but those triggered via the oral route appear with a latency of several hours. The α-Gal epitope is highly immunogenic to humans, apes and old-world monkeys, all of which produce anti-α-Gal antibodies of the IgM, IgA and IgG subclasses. Strong evidence suggests that in susceptible individuals, class switch to IgE occurs after several tick bites. In this review, we discuss the strong immunogenic role of the α-Gal epitope and its structural resemblance to the blood type B antigen. We emphasize the broad abundance of α-Gal in different foods and pharmaceuticals and the allergenicity of various α-Gal containing molecules. We give an overview of the association of tick bites with the development of AGS and describe innate and adaptive immune response to tick saliva that possibly leads to sensitization to α-Gal. We further discuss a currently favored hypothesis explaining the mechanisms of the delayed effector phase of the allergic reaction to α-Gal. We highlight AGS from a clinical point of view. We review the different clinical manifestations of the disease and the prevalence of sensitization to α-Gal and AGS. The usefulness of various diagnostic tests is discussed. Finally, we provide different aspects of the management of AGS. With climate change and global warming, the tick density is increasing, and their geographic range is expanding. Thus, more people will be affected by AGS which requires more knowledge of the disease.

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“…102,106 This could reflect a shared environmental sensitization risk from outdoor exposure, but a recent paper noted cross-reactivity between tick and wasp proteins. 107…”

Section: Box 1 Major Milestone Discoveriesmentioning

confidence: 99%

“…Associations between IgE to alpha‐gal and IgE to venom from stinging insects such as honey bees and wasps have been reported 102,106 . This could reflect a shared environmental sensitization risk from outdoor exposure, but a recent paper noted cross‐reactivity between tick and wasp proteins 107 …”

Section: Epidemiology Relationship To Ticks and Other Risk Factorsmentioning

confidence: 99%

Tick bites, IgE to galactose‐alpha‐1,3‐galactose and urticarial or anaphylactic reactions to mammalian meat: The alpha‐gal syndrome

Wilson,

Erickson,

Levin

et al. 2024

Allergy

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The recent recognition of a syndrome of tick‐acquired mammalian meat allergy has transformed the previously held view that mammalian meat is an uncommon allergen. The syndrome, mediated by IgE antibodies against the oligosaccharide galactose‐alpha‐1,3‐galactose (alpha‐gal), can also involve reactions to visceral organs, dairy, gelatin and other products, including medications sourced from non‐primate mammals. Thus, fittingly, this allergic disorder is now called the alpha‐gal syndrome (AGS). The syndrome is strikingly regional, reflecting the important role of tick bites in sensitization, and is more common in demographic groups at risk of tick exposure. Reactions in AGS are delayed, often by 2–6 h after ingestion of mammalian meat. In addition to classic allergic symptomatology such as urticaria and anaphylaxis, AGS is increasingly recognized as a cause of isolated gastrointestinal morbidity and alpha‐gal sensitization has also been linked with cardiovascular disease. The unusual link with tick bites may be explained by the fact that allergic cells and mediators are mobilized to the site of tick bites and play a role in resistance against ticks and tick‐borne infections. IgE directed to alpha‐gal is likely an incidental consequence of what is otherwise an adaptive immune strategy for host defense against endo‐ and ectoparasites, including ticks.

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Cross‐reactivity between tick and wasp venom can contribute to frequent wasp sensitization in patients with the α‐Gal syndrome

Cited by 9 publications

References 40 publications

Oral immunotherapy in alpha‐gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

Oral immunotherapy in alpha‐gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

The α-Gal epitope - the cause of a global allergic disease

Tick bites, IgE to galactose‐alpha‐1,3‐galactose and urticarial or anaphylactic reactions to mammalian meat: The alpha‐gal syndrome

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