Delayed Anaphylaxis Involving IgE to Galactose-alpha-1,3-galactose

Abstract

Hypersensitivity in the allergic setting refers to immune reactions, stimulated by soluble antigens that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. As the number of known exposures associated with anaphylaxis is limited, identification of novel causative agents is important in facilitating both education and other allergen-specific approaches that are crucial to long-term risk management. Within the last 10 years several seemingly separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins where exposure differed from airborne allergens but which were nevertheless capable of producing anaphylactic and hypersensitivity reactions. Our recent work has identified these responses as being due to a novel IgE antibody directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). This review will present the history and biology of alpha-gal and discuss our current approach to management of the mammalian meat allergy and delayed anaphylaxis.

Parasites and allergy: Observations from Africa

“…Generally, IgE to CCDs are not thought to be biologically active, but in recent years, responses to the mammalian carbohydrate epitope galactose‐α‐1,3‐galactose (α‐gal) have been of interest in the field of allergy since this epitope has been linked to two forms of anaphylaxis . The first being anaphylactic reactions following the infusion of the monoclonal antibody cetuximab among cancer patients undergoing therapy in the Southeastern United States and the second being delayed‐onset reactions hours after mammalian meat product consumption . Reactions to α‐gal have been documented from the Southeastern US, Central America, Australia and East Asia .…”

“…67 The first being anaphylactic reactions following the infusion of the monoclonal antibody cetuximab among cancer patients undergoing therapy in the Southeastern United States 68 and the second being delayed-onset reactions hours after mammalian meat product consumption. 69 Reactions to α-gal have been documented from the Southeastern US, Central America, Australia and East Asia. 67 A history of tick-bite exposure has been shown to be strongly correlated with high levels of IgE to α-gal.…”

Guía de Actuación en Anafilaxia en Latinoamérica. Galaxia-Latam

“…45 La anafilaxia retardada inducida por carnes rojas y mediada por anticuerpos IgE frente al determinante glucídico galactosa-alfa-1, 3 sido motivo de interés en los últimos años. 46 Los medicamentos que contienen estearato de magnesio de origen bovino como excipiente pueden inducir anafilaxia en pacientes alérgicos alfa-gal debido a reacciones cruzadas con subproductos de carne. 47…”

Galactose-α-1,3-galactose syndrome: an Italian survey

“…Two other papers from Brazil (12) and Japan (13) demonstrated the presence of α-Gal epitope in the saliva of other tick species, respectively Ambyomma sculptum and Haemaphysalis longicornis. The term "α-Gal syndrome" was recently proposed to better describe this novel disease that occurs worldwide (14,15) and is clinically defined by the three facets of this allergy: (a) an IgE mediated food allergy with a typically delayed onset following the ingestion of mammalian meat and innards; (b) a drug allergy to cetuximab or gelatin-based colloids, both containing many α-Gal epitopes; and (c) allergic (generally local) reactions to tick bites (16). Many cases of α-Gal syndrome have been described in Europe, particularly in Sweden, Germany and France (16,17), whereas in Italy only anecdotal cases have been reported so far (18), al- tients more than four.…”