Delayed red meat allergy: clinical ramifications of galactose-α-1,3-galactose sensitization

Mammalian meat allergy

“…Increased suspicion should be placed on patients who report spending a large amount of time outdoors or individuals living in tick‐endemic areas . Frequently reported symptoms include nausea, diarrhea, indigestion, urticaria, and angioedema usually preceded by generalized pruritus often occurring in the middle of the night . Upon interrogation, patients disclose consumption of some form of mammalian protein 3–6 hours before onset of symptoms .…”

“…Upon interrogation, patients disclose consumption of some form of mammalian protein 3–6 hours before onset of symptoms . In addition, patients describe longstanding tolerance to red meat years before onset of symptoms and continue to tolerate poultry and fish …”

“…Initially many patients tested with conventional skin prick testing (SPT) using commercial extracts of mammalian meat (beef, pork, lamb) produced negative results (small wheals 2–4 mm diameter) . As these SPT reactions do not produce robustly positive results, a diagnosis of mammalian meat allergy may be discounted which could lead to incorrect management and potentially serious anaphylaxis.…”

“…As these SPT reactions do not produce robustly positive results, a diagnosis of mammalian meat allergy may be discounted which could lead to incorrect management and potentially serious anaphylaxis. SPT with freshly prepared meat extract will elicit a strongly positive result in affected patients, and accordingly this appears to be the best means of testing for mammalian meat allergy . Accumulating evidence suggests that SPTs using cetuximab can be used to assist diagnosis, skin reactivity is often impressive and rapid, and thus this reagent could potentially be incorporated into clinical practice .…”

“…after encountering 25 cases of this phenomenon in Sydney, Australia. As well as a delayed allergic reaction to the consumption of red meat, these individuals also have an immediate onset anaphylactic reaction upon exposure to the epidermal growth factor receptor (EGFR) inhibitor cetuximab . As tick bites are common in many regions of the world, it is pertinent for dermatologists to gain familiarity with this emergent allergy as a potential cause for idiopathic delayed urticarial and anaphylaxis reactions.…”