Galactose-α-1,3-Galactose Allergy Is Not a Hitherto Unrecognized Cause of Chronic Spontaneous Urticaria

Maurer, Marcus; Church, Martin K.; Metz, Martin; Starkhammar, Maria; Hamsten, Carl; Hage, Marianne van

doi:10.1159/000440653

Cited by 10 publications

(10 citation statements)

References 10 publications

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“…Taken together the name ‘α-gal syndrome’ seems an appropriate descriptor. Although anecdotally we have seen a few cases of chronic urticaria in α-gal patients on full avoidance diets, a recent report from Sweden did not substantiate a link [26]. …”

Section: Red Meat Allergy and Morementioning

confidence: 98%

Galactose-α-1,3-Galactose: Atypical Food Allergen or Model IgE Hypersensitivity?

Wilson

Schuyler

Schroeder

et al. 2017

Curr Allergy Asthma Rep

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Purpose of Review Galactose-α-1,3-galactose (α-gal) is a carbohydrate allergen with several unique characteristics. In this article, we discuss some recent advances in our understanding of the ‘alpha-gal syndrome,’ highlight data supporting the role of ticks in pathogenesis, and speculate on immune mechanisms that lead to sensitization. Recent Findings First described as the target of IgE in individuals suffering immediate hypersensitivity reactions to the novel anti-EGF monoclonal antibody cetuximab, it is now clear that α-gal sensitization is associated with mammalian meat allergy as well as reactions to other mammalian products. Unlike traditional IgE-mediated food allergies, reactions to α-gal often do not manifest until several hours following an exposure, although co-factors can influence the presentation. Multiple pieces of evidence, including recent work with a mouse model, point to the fact that sensitization is mediated by exposure to certain hard ticks and increasingly we are aware of its globally widespread impact. Summary The oligosaccharide α-gal represents a novel allergen with several unusual clinical features. It has been recognized now on multiple continents and its clinical presentation can be quite variable. Moreover, efforts to delineate the mechanisms leading to α-gal sensitization may have ramifications for our broader understanding of type 2 immunity.

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Section: Red Meat Allergy and Morementioning

confidence: 98%

Galactose-α-1,3-Galactose: Atypical Food Allergen or Model IgE Hypersensitivity?

Wilson

Schuyler

Schroeder

et al. 2017

Curr Allergy Asthma Rep

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“…Maurer et al. 7 reported a prevalence of α‐gal sensitization of 2.4% in 83 patients with CU and no association between ingestion of red meat and development of subsequent delayed urticaria symptoms. In contrast, Pollack et al.…”

Section: Tablementioning

confidence: 99%

“…Maurer et al 7 reported a prevalence of α-gal sensitization of 2.4% in 83 patients with CU and no association between ingestion of red meat and development of subsequent delayed urticaria symptoms. In contrast, Pollack et al 8 found that 9 (60%) of 15 α-gal sensitized CU patients had remission of urticaria symptoms due to avoidance of red meat or other mammalian-derived food products.…”

mentioning

confidence: 99%

Prevalence, predictors, and clinical relevance of α‐gal sensitization in patients with chronic urticaria

Pedersen

Sørensen

Madsen³

et al. 2022

Clinical & Translational All

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Background Little is known about α‐gal (galactose‐α‐1,3‐galactose) sensitization in patients with chronic urticaria (CU). The aim of this study was to examine the prevalence, predictors and clinical relevance of α‐gal sensitization in patients with CU. Methods Two consecutive cohorts of newly referred patients with CU from a primary care allergology practice and a tertiary hospital dermatology department, plus a control group with allergic disease, but not CU, from the allergology practice, were interviewed and screened for α‐gal sensitization (serum specific‐IgE ≥0.35 KU/L). Results Of 733 patients included, 21 (5.6%) and 11 (3.9%) of CU patients from private practice and hospital, respectively, were α‐gal sensitized. In total, 8 patients (38.1% of sensitized patients, and 2.1% of all CU patients) from private practice, and 2 patients (18.2% of sensitized patients, and 0.7% of all CU patients) from hospital, had clinically relevant α‐gal allergy. In private practice, male sex (47.6 vs. 24.7%), p = 0.020, obesity (33.3 vs. 23.6%), p = 0.302, and frequency of angioedema (61.9 vs. 51.4%), p = 0.350; and in hospital, male sex (72.7 vs. 27.9%), p = 0.003, and high total immunoglobulin E (median 168 vs. 70.5 KU/L), p = 0.022 were associated with α‐gal sensitization. Conclusion α‐gal sensitization is observed in a small fraction of CU patients with only few patients experiencing clinically relevant sensitization. Certain patients, particularly from primary care, may constitute a relevant population for aimed testing.

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“…Pollack et al noted remission of symptoms in such patients on avoiding mammalian meat 16 . In contrast Maurer et al reported the absence of urticarial symptoms, even when patients with detectable levels of anti‐α‐gal IgE consumed red meat 17 Elimination of fish and fish products …”

Section: Elimination Dietsmentioning

confidence: 99%

“…Dietary elimination of fish or fish products and mammalian meat or meat products has Grade B recommendation each, while dietary elimination of gluten has Grade C recommendation (Table 3 ) 16,17,19–22,24–41 . However, elimination diets may be tried in a subset of refractory CSU patients, for example, those with a history of anaphylaxis, resident of tick endemic areas for AGS, or confirmed coexistence of food allergy by a double‐blind placebo‐controlled food challenge, when benefits outweigh risks.…”

Section: Elimination Dietsmentioning

confidence: 99%

Dietary strategies for chronic spontaneous urticaria: an evidence‐based review

2021

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Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective.Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and lowhistamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.

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Galactose-α-1,3-Galactose Allergy Is Not a Hitherto Unrecognized Cause of Chronic Spontaneous Urticaria

Cited by 10 publications

References 10 publications

Galactose-α-1,3-Galactose: Atypical Food Allergen or Model IgE Hypersensitivity?

Galactose-α-1,3-Galactose: Atypical Food Allergen or Model IgE Hypersensitivity?

Prevalence, predictors, and clinical relevance of α‐gal sensitization in patients with chronic urticaria

Dietary strategies for chronic spontaneous urticaria: an evidence‐based review

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